PMC2639604_01
PMC2639604_02
Transesophageal echocardiogram (midesophageal view) with echodensities in the right atrial free wall, right ventricular free wall and atrioventricular groove (arrows).
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PMC2639604_02_1752-1947-3-2-1.jpg
F1
To better define the mass and its anatomic relationship within the RA, several imaging procedures were performed: 1) transesophageal echocardiogram (TEE) showing a 5.7 cm2 shaped echodensity within the wall of the RA and a second, 16 cm2 echodensity, that extended across the atrioventricular groove (Figure 1); 2) a contrast computed tomography (CT) of the chest, abdomen and pelvis negative for metastasis, but significant for a large pericardial effusion without pericardial thickening and a 2.6 x 2.1 cm filling defect in the right atrial appendage (Figure 2); and 3) a cardiac MRI demonstrating a homogenous enhancing mass along the lateral wall of the right atrium.
Contrast-enhanced computed tomographic axial image demonstrating filling defects (arrows) corresponding to echocardiographic findings.
1752-1947-3-2-2.jpg
PMC2639604_02_1752-1947-3-2-2.jpg
F2
To better define the mass and its anatomic relationship within the RA, several imaging procedures were performed: 1) transesophageal echocardiogram (TEE) showing a 5.7 cm2 shaped echodensity within the wall of the RA and a second, 16 cm2 echodensity, that extended across the atrioventricular groove (Figure 1); 2) a contrast computed tomography (CT) of the chest, abdomen and pelvis negative for metastasis, but significant for a large pericardial effusion without pericardial thickening and a 2.6 x 2.1 cm filling defect in the right atrial appendage (Figure 2); and 3) a cardiac MRI demonstrating a homogenous enhancing mass along the lateral wall of the right atrium.
High power histologic examination showing the epicardium with lymphoplasmocytic infiltration (hematoxylin-eosin stain).
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PMC2639604_02_1752-1947-3-2-3.jpg
F3
However, the visceral pericardium showed a lymphoplasmocytic infiltrate diagnostic of epicarditis (Figure 3).