_24_KP_6_2021__Piatkowski
  • „ CLINICAL VIGNETTE

Giant right atrial tumor in three-dimensional echocardiographic imaging

Radosław Piątkowski, Monika Budnik, Michał Konwerski, Krzysztof Ozierański, Janusz Kochanowski

1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland

Correspondence to:

Monika Budnik, MD, PhD,

1st Chair and Department of Cardiology,

Medical University of Warsaw,

Banacha 1A, 02–097 Warszawa, Poland,

phone: +48 22 599 26 12,

e-mail: moni.budnik@gmail.com

Copyright by the Author(s), 2021

Kardiol Pol. 2021; 79 (6): 714–715; DOI: 10.33963/KP.15963

Received: March 14, 2021

Revision accepted: April 11, 2021

Published online: April 16, 2021

A 73-year-old woman was admitted to the hospital due to weakness, shortness of breath, and ankle edema. Symptoms had manifested one month before. She had a history of hypertension.

Transthoracic echocardiography revealed a dilated right atrium (RA) with an extremely large tumor occupying the entire RA. The mass did not extend into the inferior vena cava and it appeared to infiltrate the right wall and visceral pericardium. Moreover, pericardial and bilateral pleural effusions were present (Figure 1A).

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Figure 1. A. 2D transthoracic echocardiography, subcostal modified 4-chamber view. B. 2D TEE, modified bicaval view. C. 3D TEE, modified bicaval view. D. 2D TEE, modified 4-chamber view. E. 2D TEE, bicaval view. F. 3D TEE, bicaval view. Red arrow shows mass in the RA, green arrow shows tumor infiltration of the visceral pericardium, blue arrow shows tumor infiltration of the RA wall.

Abbreviations: IAS, interatrial septum; LA, left atrium; RA, right atrium; RV, right ventricle; SVC, superior vena cava; TEE, transesophageal echocardiography; TV, tricuspid valve

We performed transesophageal echocardiography (TEE) which showed that the diameter of the tumor was about 80 × 66 mm (Figure 1B; Supplementary material, Video S1). Using three-dimensional imaging, we could see in detail that the mass was immobile, inhomogeneous, and non-pedunculated (Figure 1C; Supplementary material, Video S2). The tricuspid valve was not involved but inflow to the right ventricle was significantly reduced (Figure 1D; Supplementary material, Video S3). The tumor infiltrated the superior vena cava (Figure 1EF; Supplementary material, Video S4, S5). Color Doppler study documented vasculature of the tumor indicating it is malignant nature (Supplementary material, Video S6). Computed tomography ruled out the presence of a tumor in other organs.

Primary cardiac tumors are extremely rare [1]. Most of them are benign and only approximately 25% [2] are malignant. The general prognosis is poor and the mean survival is about three months to one year after radical resection [3]. However, resection is often impossible. Unfortunately, the patient had a sudden cardiac arrest from pulseless electrical activity and died. The result of the histopathological exam was angiosarcoma.

Echocardiography is the method of choice in diagnosis cardiac masses and 3D TEE allows to add exact information about the location, mobility, attachment and wall infiltration of the tumor [4].

Supplementary material

Supplementary material is available at https://journals.viamedica.pl/kardiologia_polska.

Article information

REFERENCES

  1. 1. Silverman NA. Primary cardiac tumor. Ann Surg. 1980; 191(2): 127138, doi: 10.1097/00000658-198002000-00001, indexed in Pubmed: 7362282.
  2. 2. Szerszyńska A, Nowak R, Łaskawski G, et al. Recurrent pneumonia and pulmonary embolism in a young patient as a presentation of right ventricular myxoma. Kardiol Pol. 2019; 77(1): 63, doi: 10.5603/KP.2019.0008, indexed in Pubmed: 30672582.
  3. 3. Herrmann MA, Shankerman RA, Edwards WD, et al. Primary cardiac angiosarcoma: a clinicopathologic study of six cases. J Thorac Cardiovasc Surg. 1992; 103(4): 655664, indexed in Pubmed: 1548908.
  4. 4. Riles E, Gupta S, Wang DD, et al. Primary cardiac angiosarcoma: a diagnostic challenge in a young man with recurrent pericardial effusions. Exp Clin Cardiol. 2012; 17(1): 3942, indexed in Pubmed: 23204900.

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