IMAGES IN CARDIAC SURGERY
Eggshell right atrial mass
Zhikui Chen Ms
Guangze Xu Ms
Haiyan Lin MD
Department of Cardiology, Lihuili Hospital, Ningbo, Zhejiang, P.R. China
Guangze Xu Ms, Department of Cardiology, Lihuili Hospital, 57# Xingning Rd., Ningbo, Zhejiang, P.R. China.
Most organized myocardial thrombi appear as a left atrial mass in
patients with rheumatic mitral stenosis and atrial fibrillation.
atrial thrombi in the absence of atrial fibrillation have been associated
with amplatzer occluders for atrial septal defects.
We present images
of a patient with a thrombotic right atrial mass without any underlying
A 70-year-old female was referred for evaluation of a spherical,
calcified mass seen on a routine chest X-ray (arrow in Figure 1A). There
was no history of atrial fibrillation, valvular disease, or previous cardiac
surgery. Her physical examination was unremarkable and an electro-
cardiogram showed normal sinus rhythm. A transthoracic echocardio-
A contrast-enhanced computed tomography scan showed an
extensively calcified right atrial mass (Figure 1C). A coronary angiogram
showed an avascular mass without any coronary artery disease
(Figure 1D). At the time of surgery, following initiation of cardiopulmo-
nary bypass and cardiac arrest, the right atrium was opened and a
5 × 4 × 3-cm egg-shaped mass with a fibrous pedicle was noted to be
attached to the interatrial septum inferior to the fossa ovalis. The mass
was easily excised and the septum remained intact. The patient
tolerated the procedure well and had an uncomplicated post-operative
course. On gross examination, the mass had a firm, hard shell
(Figures 2A and 2B). Microscopic examination revealed an organized
thrombus with focal cellular infiltration and fibrous tissue encapsulation
(Figures 3A and 3B). A follow-up TTE at 8 months showed no residual
atrial mass. The patient remains in normal sinus rhythm.
FIGURE 1 A, A chest X-ray showed a spherical mass (arrow) with circumferential calcification. B, Transthoracic echocardiography revealed
a calcified, mobile, oval mass with hyperechogenicity. C, Computed tomography showed an unenhanced oval mass with extensive calcification
on surface. D, The mass was clearly visible during digital substraction angiography
J Card Surg. 2018;33:101–102. wileyonlinelibrary.com/journal/jocs © 2018 Wiley Periodicals, Inc.