PMC7864283_01
Longitudinal right atrial pseudoaneurysm development on lung CT images. (A) A baseline CT image (enhanced) scanned before initiating the intrapericardial chemotherapy revealed PE and intact RA free wall. (B) A non-contrast-enhanced CT image scanned after five intrapericardial and three systemic cycles of chemotherapy demonstrated decreased PE and intact RA free wall. (C-F) Non-contrast-enhanced CT images after the fifth, sixth, seventh, and ninth systemic cycles of chemotherapy showed the growth of a crescent-shaped soft tissue lesion near the RA. The lesion density after the fifth systemic chemotherapy cycle was mixed.
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F1
Baseline CT images (enhanced) were compared to scans before intrapericardial perfusion chemotherapy and showed that PE was significant near the RA with a CT value of about eight Hounsfield units (Figure 1A). Non-contrast-enhanced CT images obtained after five cycles of intrapericardial chemotherapy and three cycles of systemic chemotherapy demonstrated decreased PE (Figure 1B). After the fifth, sixth, and seventh cycles of systemic chemotherapy, the non-contrast-enhanced CT images showed the growth of a crescent-shaped lesion with soft tissue density near the RA (Figures 1C-E). The lesion density after the fifth cycle of systemic chemotherapy was mixed (Figure 1D). After the ninth cycle of systemic chemotherapy, the non-contrast-enhanced CT images showed that the lesion was larger at a size of around 109 x 89 mm (Figure 1F).
(A-C) Echocardiography after the ninth systemic chemotherapy cycle revealed a large rupture in the RA (arrow) that bulged outwards to form a large cyst having a size of ~49 x 71 mm (*). A low echogenic region was attached to the capsule with a range of 98 mm and a thickness of 38 mm (*).
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F2
Transthoracic 3-D echocardiography after the ninth cycle of systemic chemotherapy detected an anechoic area measuring 49 x 71 mm attached to the lateral side of the RA (Figure 2A). There was a weak echo in the area with a range of 98 mm and a thickness of ~36 mm (Figures 2B,C).
The right atrial pseudoaneurysm with a mural thrombus on CMR images acquired after the ninth systematic chemotherapy cycle. The T1-weighted (T1WI) (A) and T2-weighted (T2WI) (B) images in a 4-chamber view revealed a crescent-shaped heterogeneous signal of 87 x 43 mm in size (+) and a striped isogenic signal (thickened pericardium) of 3-8 mm in width (arrows). An early enhanced T1WI image (C) and late gadolinium-enhanced imaging (D) illustrate diffuse enhancement within a striped lesion.
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F3
The CMR images (as shown in Figure 3) revealed an extra cavity adjacent and connected to the RA with an extensive mass adherent to the right wall of the cavity.