An unusual finding in the right atrium.
A 66-year-old asymptomatic patient underwent a routine transthoracic echocardiogram prior to commencement of clozapine, and was found to have a mobile echogenic structure in the right atrium, which was later confirmed on transoesophageal echocardiogram to be adjacent to the insertion of inferior vena cava.Follow-up cardiovascular MRI (CMR) revealed a mobile, avascular 2.1×2.2 cm2mass with regular and smooth borders, adjacent to the eustachian valve (Figure 1 panel A: coronal view; online supplementary movie 1). Late gadolinium enhancement (LGE; panel B) demonstrated heterogeneity, and T1-imaging demonstrated mild hyperintensity (panel C). There was no evidence of obstructive haemodynamic compromise.The mass was subsequently resected, and the histology (H&E staining, magnification ×100) is shown in panel D.



The diagnosis of this mass is: Aberrant liverAngiosarcomaAtrial myxomaRenal cell carcinomaThrombus.
Department of Cardiology, Northern Hospital, Epping, Victoria, Australia.|Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
Chee Loong
CL
Chow
Department of Cardiology, Northern Hospital, Epping, Victoria, Australia.
Sylvia S M
SS
Chen
Department of Cardiology, Northern Hospital, Epping, Victoria, Australia.|Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
William
W
van Gaal
D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging*; D002828:Choristoma / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D006325:Heart Atria / Q000000981:diagnostic imaging; D006338:Heart Neoplasms / Q000175:diagnosis; D006801:Humans; D008099:Liver; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male