Rapidly Progressive Right Atrial Mass Secondary to Metastatic Hepatocellular Carcinoma.

Although the differential diagnosis for cardiac masses is broad and includes both benign and malignant primary cardiac tumors, metastases of noncardiac primary malignancies to the heart are an important etiology. We present an unusual case of a rapidly progressive right atrial mass caused by metastatic hepatocellular carcinoma.

A Challenging Diagnosis of Behçet's Disease Starting from Unexplained Fever Recurrence with Pulmonary Embolism: A Case Report.

Purpose: Recurrent inflammatory fevers with multisystem involvement occur clinically and may indicate an autoimmune disease. Case: We present a young male diagnosed with pulmonary embolism who experienced recurrent fever during hospitalization and was unresponsive to antibiotics and antipyretics. A follow-up history revealed chronic oral and genital ulcers, leading to a final diagnosis of Behçet's disease. Conclusion: The patient's temperature normalized rapidly after corticosteroid therapy, and infection markers returned to normal. Complete remission was achieved with immunosuppression and glucocorticoid therapy. Reporting characteristics, treatment experience, and outcomes of such cases are essential to inform future diagnosis and management strategies.

Hot Air Balloon in the Left Atria.

A 54-year-old patient with a medical history of hypertension, dyslipidemia, and diabetes underwent mitral valve replacement surgery with a biologic valve. During a chest computed tomography scan for breast neoplasia staging, a reduced luminal filling in the left atrium (3.6 cm) was unexpectedly found, prompting further cardiac evaluation. The patient was referred to the emergency department experiencing shortness of breath and fatigue, which improved after furosemide administration, and remaining stable throughout hospitalization. A transesophageal echocardiogram was performed the following day and revealed a biologic mitral valve prosthesis slightly displaced toward the left ventricle with an average transprosthetic gradient of 7 mmHg. Notably, a sizable intermediate echogenic mass measuring 3.0 cm × 3.5 cm was detected and attached to the prosthesis ring in a lateral and posterior position, within the left atrium. A mild degree of periprosthetic regurgitation was also noted. Given the substantial suspicion that the observed mass was a thrombus, the patient was commenced on anticoagulation therapy while awaiting cardiac magnetic resonance imaging for better characterization of the mass. Over 4 weeks, the thrombus notably decreased in size, disappearing entirely by the 6th week. This case highlights the significance of employing multiple imaging techniques in managing cardiac masses. The incidental discovery of the mass, its characterization, and subsequent management through anticoagulation, followed by confirmation and monitoring through echocardiogram, underscore the importance of a multimodal approach in diagnosing and treating such conditions.

Diffuse Large B-cell Lymphoma Presenting as a Cardiac Mass.

Cardiac involvement as the initial presentation of lymphoma is a rare occurrence. The most common type of cardiac lymphoma is diffuse large B-cell lymphoma (DLBCL), which often affects the right atrium. Cardiac lymphoma can either be mediastinal DLBCL invading the heart or primary cardiac lymphoma. We describe the case of an 84-year-old female who presented with an eight-week history of dyspnea. Computed tomography angiography (CTA) of the chest showed a right-sided pleural effusion with collapse of the right middle and lower lobes as well as a large mass-like density within the anterior pericardium, compressing the right atrium and right ventricle and encasing the right coronary artery. A transthoracic echocardiogram (TTE) showed a multilocular hypoechoic mass in the right atrium with invasion into the wall of the right atrium. The patient underwent diagnostic and therapeutic thoracentesis. Pleural fluid cytology revealed diffuse large B-cell lymphoma, with positive stains for CD20, PAX5, CD10, BCL6, and Mum-1. Fluorescence in situ hybridization (FISH) revealed an abnormality of BCL2/18q (16%). A staging positron emission tomography (PET) scan showed a large mediastinal mass involving the right pericardium, focal uptake in the left thyroid lobe, left skull base, and musculature around the proximal left femur. Chemotherapy was initiated with R-mini-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). PET scans after three cycles of chemotherapy showed a complete metabolic response with the resolution of previously noted hypermetabolic lesions. The patient completed all six cycles of chemotherapy without issues. The differential diagnosis of a right atrial cardiac mass should include lymphoma. TTE is usually the initial imaging test, and a tissue biopsy is required for a definitive diagnosis. DLBCL is highly aggressive and carries a poor prognosis if untreated. Early diagnosis and treatment with standard chemotherapy are crucial for favorable outcomes.

Metastatic right atrial mass in the presence of atrial septal defect: A rare clinical coincidence.

Key Clinical Message: The key takeaway from this clinical scenario is to choose the most appropriate and reasonable treatment plan when dealing with a patient who has atrial septal defect (ASD) and concurrent atrial and mediastinal masses. In such cases, a heart-oncology team should make the therapeutic decision. Abstract: Right atrial masses are not pretty rare and might be a diagnostic challenge. Thrombosis, tumors, and vegetations are primary differential diagnoses. Workup for these masses usually includes multimodality imaging and biopsy in selected cases. We report a case of a 37-year-old lady who presented with cough, dyspnea, and head and neck swelling after a cesarean section. Echocardiography revealed a right atrial mass accompanied by a secundum type atrial septal defect (ASD). Pulmonary CT Angiography was performed, in which a lobulated mass in the anterior mediastinum was detected, and a heart-oncology team made the therapeutic decision. The patient was scheduled for surgical ASD closure and concomitant tissue biopsy. The pathology results were in favor of poorly differentiated germ cell tumors, and chemotherapy was started following the surgery. After two sessions of chemotherapy, the tumor did not respond to the primary regimen. Thus, an updated regimen was initiated. Compliance with the updated regimen was acceptable, and the patient is currently under treatment and follow-up.

Complex decision making in a patient with lung cancer with incidentally found fast-growing atrial mass.

Atrial myxomas are typically found in the left atrium and are the most common among overall rare cardiac tumors. Herein, we describe the clinical course of a 72-year-old female with non-small cell lung adenocarcinoma found to have an atrial mass during an imaging for evaluation for lung cancer progression. Differentiating between distinct types of masses can pose a challenge to the treatment team especially in the setting of exiting malignancy. This case demonstrates the complex decision making involved in the diagnosis, and timing of intervention to remove atrial mass in patients with frailty and a fast-growing cardiac mass.

The cardiovascular effects of large hiatal hernias: a narrative review of cases and studies.

Hiatal hernia (HH) is a common disease in the general population. It is often asymptomatic, but if it does present clinical manifestations, these are usually gastrointestinal. Gastroesophageal reflux is the main symptom that accompanies it. Depending on the severity of the hernia, it is classified into several subtypes from I-IV. Especially, IV type (giant HH) can lead to various cardiopulmonary symptoms with several degrees of severity. It is necessary to keep this possibility in mind among the various differential diagnoses that may occur in this clinical setting. The current paper aims to review the literature on classic and novel information on the HH - cardiovascular system relationship. Epidemiological data, physiological aspects of the heart compressed by HH, cardiovascular symptoms, electrocardiographic changes, echocardiographic alterations and clinical implications are discussed.

Normally, the stomach and the heart are not in direct contact because they are in different cavities, the thorax and the abdomen, respectively. When part of the stomach moves toward the chest through the diaphragm, we say there is a hiatal hernia (HH). Most of the time the HH symptoms are mild and clearly digestive. In severe cases, surgical repair of the HH is required. Even in these circumstances, digestive symptoms continue to be the most frequent. However, some patients present cardiovascular symptoms and few or no digestive symptoms. This easily creates diagnostic confusion, which leads to incorrect treatments and unnecessary expenses. In extreme cases, as seen in giant HH, the degree of cardiovascular involvement is very serious. There are documented cases that have suffered cardiac arrest, arrhythmias of different types and symptoms like classic acute myocardial infarction. It is required that clinical doctors and surgeons are aware that this complication exists. Only with this in mind can a timely diagnosis be achieved. Some emergency measures have been saving, gastric decompression with a tube being the most important. The main mechanism that explains the serious cardiovascular consequences of giant HH is cardiac compression. The dissemination of this knowledge can help save lives.

Ewing's sarcoma of kidney extending into IVC and RA: resection using modified cannulation strategy for CPB.

Ewing's sarcoma of the kidney is a rare tumor. Although renal carcinomas are known to involve the inferior cava, extension of the tumor up to the right atrium is not common. In the majority of cases when the tumor extends into the infrahepatic part of the inferior vena cava, it can be removed from the abdominal approach. Few patients require the use of cardiopulmonary bypass for removal of the tumor in the inferior vena cava and right atrium. The management of patients requiring resection of kidney tumors and right atrial mass is more complicated and requires a team approach consisting of oncosurgeons, cardiac surgeons, and cardiac anesthetists. The resection of the kidney tumor with a mass in the right atrium is usually done concomitantly. The cardiopulmonary bypass cannulation strategy needs to be modified in such cases.

Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis.

The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.

Catheter-Related Right Atrial Endocarditis in a Dialysis Patient.

Hemodialysis catheters are frequently used for vascular access in end-stage chronic kidney disease patients lacking mature arteriovenous fistula. The incidence of infective endocarditis in hemodialysis patients is higher than in the general population and is associated with severe and potentially life-threatening complications. A high index of suspicion is imperative for early diagnosis and timely intervention to enhance the prognosis of this high-mortality condition. Imaging studies, like transthoracic and transesophageal echocardiography, are crucial for prompt diagnosis. We present a case of a 36-year-old woman undergoing hemodialysis, whose prolonged use of a permanent catheter led to the development of infective endocarditis complicated with septic pulmonary embolism. Our case report presents an example of right atrial endocarditis with a poor outcome due to delayed diagnosis.

Successful tricuspid valve repair and right atrial mass excision for calcified thrombus causing severe tricuspid regurgitation and near-occlusion of inferior vena cava.

BACKGROUND: Calcified right atrial thrombus is rare and commonly occurs secondary to atrial fibrillation and long-term central venous catheterization which present risk for embolization. Treatment typically involves anticoagulation and antiplatelet therapy but rarely surgical excision can be performed, especially in patients with venous obstruction or concomitant valvular dysfunction. CASE PRESENTATION: We present the case of a 69 year old symptomatic female with a history of atrial fibrillation and long-term venous catheterization found to have a large calcified right atrial thrombus causing inferior vena cava obstruction and severe tricuspid regurgitation. Patient underwent full median sternotomy with ascending arterial cannulation with superior vena cava and femoral venous cannulation. Intraoperatively, extensive right atrial calcified thrombus was found extending into the inferior vena cava and involving the septal portion of the tricuspid valve annulus causing regurgitation. The calcified thrombus was removed which resolved the inferior vena cava obstruction and the tricuspid valve was repaired by transecting septal leaflet chordae, commissuroplasty, and ring annuloplasty. Postoperative course was uncomplicated and pathology confirmed a calcified right atrial thrombus. At 6 month follow up, the patient was asymptomatic with echocardiogram showing no inferior vena cava stenosis and trivial tricuspid regurgitation. CONCLUSIONS: Surgical excision of calcified right atrial thrombus is rare and is often indicated for symptomatic patients with extensive involvement causing venous inflow obstruction or valvular dysfunction. Sufficient preoperative imaging and a multi-disciplinary approach are essential for accurate diagnosis to guide targeted treatment. When the tricuspid valve is involved, repair is preferred over replacement in this patient population given their propensity for calcification and thrombus formation which may result in an increased risk of early bioprosthetic valve degeneration or mechanical valve thrombosis.

Isolated primary cardiac angiosarcoma.

Cardiac angiosarcoma (CAS) is the most prevalent malignant primary cardiac tumor in adults, often affecting young males. We present a case of this rare entity in a young female, highlighting the multidisciplinary team's role and multimodality imaging in the diagnosis and management.

Hot-snare assisted percutaneous mechanical aspiration of a calcified amorphous tumor.

A 24-year-old female with history of an atrial septal defect post-patch closure (bovine pericardium) presented 4 years postoperative with an incidentally identified mass originating from the septal patch .

Prolapsing Intrigue: A Case of Superior Vena Cava Mass Visualized by Echocardiography From the Subcostal Window Unveiling an Anterior Mediastinal Type B2 Thymoma.

Imaging the superior vena cava (SVC) during two-dimensional (2D) transthoracic echocardiographic examination is challenging and should be performed routinely. Here, we present a case where a lower (juxta-atrial) SVC mass was seen prolapsing into the right atrium by 2D transthoracic echocardiography; in this case, the imaging of the lower (juxta-atrial) SVC was done from the subcostal window. It was not possible to image the SVC from the suprasternal, right supraclavicular, left parasternal, or apical windows. CT scan of the chest with intravenous contrast was done in this case and showed an anterior mediastinal mass invading the SVC and prolapsing into the right atrium. CT-guided biopsy proved the mass to be a type B2 thymoma.

Primary Cardiac Sarcoma, Diagnostic and Therapeutic Challenges in Resource Limited Setting: Case Report.

Left atrial masses are commonly caused by atrial myxomas and metastatic tumors. Primary cardiac sarcomas are rare. Patients present with symptoms related to the tumor location. There are only a few case reports on this rare disease. We report the case of a 17 years old male patient presented with shortness of breath for 2-month duration. Echocardiography revealed a left atrial mass that was later surgically excised and histopathology confirmed a primary cardiac sarcoma. We discuss the diagnostic and therapeutic challenges encountered in the management of this rare disease. To the best of our knowledge, this is the first case reported in East Africa.

Left Atrial Masses: Now You See Them, Now You Don't.

Left atrial masses are rare but clinically significant findings, which can present as diverse pathological entities, including primary tumors, thrombi, and metastases. Their diverse pathological entities contribute to a wide range of clinical manifestations, often presenting with nonspecific symptoms that pose challenges for early diagnosis. Within the realm of medicine, unique presentations emphasize the intricate interplay between the size, location, and functional impact of pathological processes. They serve as reminders to healthcare providers to approach each patient as an individual, recognizing that even seemingly minor abnormalities can have significant consequences. To illustrate this, we present two distinct cases of patients with left atrial masses, showcasing the importance of clinical suspicion and a wide knowledge base in identifying and managing these conditions effectively.