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Multimodality Imaging of Right Atrial Masses
Journal of the American College of Cardiology © 2010 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 55, No. 8, 2010 ISSN 0735-1097/10/$36.00 doi:10.1016/j.jacc.2009.04.106
IMAGES IN CARDIOLOGY
Multimodality Imaging of Right Atrial Masses Patricia Campbell, MD, Robert F. Padera, MD, PHD, Michael M. Givertz, MD Boston, Massachusetts
A
B Right atrial → ↓ masses
Right atrial mass subcostal view →
C
← Absent
left PA
D
Right atrialatrial mass Right
mass
Right PA → Bioptome Bioptome
Main Filling defect from right atrial mass →
C1
E
H&E Stain
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts. Manuscript received April 22, 2009, accepted April 29, 2009.
A
WT-1 Stain
76-year-old man presented with 2 months of dyspnea, early satiety, and lower extremity edema. Ten years previously, he underwent left extrapleural pneumonectomy for mesothelioma but had chest wall and mediastinal recurrences that required systemic chemotherapy and local radiation. Transthoracic echocardiography revealed right atrial dilation with a 4.9 ⫻ 6.4 cm mass attached to the anterior and inferior right atrial walls (A). Cardiac magnetic resonance imaging demonstrated 2 right atrial masses with gadolinium enhancement indicating vascularity: a 5.2 ⫻ 4.7 cm mass on the superior free wall, and a 4 ⫻ 4 cm mass partially obstructing inferior venal caval inflow on the lateral free wall (B). Right ventriculography (C) and echocardiographicguided biopsy (pulmonary artery) (D) were performed (Online Videos 1, 2, 3 and 4). Histopathology confirmed the diagnosis of epithelioid-type mesothelioma (hematoxylin and eosin [H&E] stain, E, left; WT-1 stain positive for calretinin, E, right). The patient was not a candidate for surgical resection and died of progressive metastatic mesothelioma.
Vol. 55, No. 8, 2010 ISSN 0735-1097/10/$36.00 doi:10.1016/j.jacc.2009.04.106
IMAGES IN CARDIOLOGY
Multimodality Imaging of Right Atrial Masses Patricia Campbell, MD, Robert F. Padera, MD, PHD, Michael M. Givertz, MD Boston, Massachusetts
A
B Right atrial → ↓ masses
Right atrial mass subcostal view →
C
← Absent
left PA
D
Right atrialatrial mass Right
mass
Right PA → Bioptome Bioptome
Main Filling defect from right atrial mass →
C1
E
H&E Stain
From the Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts. Manuscript received April 22, 2009, accepted April 29, 2009.
A
WT-1 Stain
76-year-old man presented with 2 months of dyspnea, early satiety, and lower extremity edema. Ten years previously, he underwent left extrapleural pneumonectomy for mesothelioma but had chest wall and mediastinal recurrences that required systemic chemotherapy and local radiation. Transthoracic echocardiography revealed right atrial dilation with a 4.9 ⫻ 6.4 cm mass attached to the anterior and inferior right atrial walls (A). Cardiac magnetic resonance imaging demonstrated 2 right atrial masses with gadolinium enhancement indicating vascularity: a 5.2 ⫻ 4.7 cm mass on the superior free wall, and a 4 ⫻ 4 cm mass partially obstructing inferior venal caval inflow on the lateral free wall (B). Right ventriculography (C) and echocardiographicguided biopsy (pulmonary artery) (D) were performed (Online Videos 1, 2, 3 and 4). Histopathology confirmed the diagnosis of epithelioid-type mesothelioma (hematoxylin and eosin [H&E] stain, E, left; WT-1 stain positive for calretinin, E, right). The patient was not a candidate for surgical resection and died of progressive metastatic mesothelioma.