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. 2024 Jun 28;11(7):004660.
doi: 10.12890/2024_004660. eCollection 2024.

Right Atrial Thrombus Masquerading as Myxoma

Shahad Alchalabi  1 , Abdulrahman S Museedi  2
Affiliations

Right Atrial Thrombus Masquerading as Myxoma

Shahad Alchalabi et al. Eur J Case Rep Intern Med. .

Abstract

Introduction: In-situ right atrial (RA) thrombus is a rare occurrence typically associated with heightened inflammatory or hypercoagulable states. Here, we present a case of in-situ RA thrombus mimicking atrial myxoma in a patient with sepsis and bacteraemia.

Case description: A 41-year-old man presented with septic arthritis and bacteraemia caused by methicillin-resistant Staphylococcus aureus (MRSA). A transoesophageal echocardiogram revealed a large pediculated mass resembling atrial myxoma, which was not visible on transthoracic echocardiography performed four days earlier. Cardiac magnetic resonance (CMR) imaging strongly suggested a thrombus, leading to the patient undergoing transcatheter aspiration. Subsequent pathology confirmed an organised fibrin thrombus without evidence of infection.

Discussion: The patient's in-situ RA thrombus likely developed in response to a heightened inflammatory state associated with sepsis. Limited data exist on in-situ RA thrombi in the absence of atrial fibrillation, though some reports suggest a correlation between heightened inflammation and a hypercoagulable state.

Conclusion: CMR imaging is invaluable for characterising such masses and can aid in distinguishing a thrombus from a myxoma.

Learning points: Differentiating right atrial (RA) thrombus from myxoma: cardiac magnetic resonance imaging is essential for distinguishing RA thrombus from myxoma, preventing unnecessary surgeries.Hypercoagulable and inflammatory states: spontaneous in-situ RA thrombi can occur without deep vein thrombosis (DVT) or atrial fibrillation, especially in hypercoagulable and inflammatory conditions.Transcatheter aspiration: this less invasive alternative to surgery is effective for large, mobile RA thrombi, reducing embolisation risk.

Keywords: Right atrial thrombus; cardiac mass; transcutaneous aspiration.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
A) TEE displaying a spherical mass connected to the septal segment of the tricuspid valve annulus via a stalk; B) The mass protrudes into the right ventricle during diastole.
Figure 2
Figure 2
Three-dimensional TEE revealing the structure of the mass.
Figure 3
Figure 3
MRI T1 image indicating the absence of enhancement in the mass.
Figure 4
Figure 4
MRI perfusion image demonstrating the absence of blood flow perfusion in the mass.
See this image and copyright information in PMC

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