PMC5654271_01
EKG showing typical atrial flutter with variable AV block.
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EKG was done and showed typical atrial flutter with variable AV block and rapid ventricular response (Figure 1).
Apical 4 chamber view of 2D echocardiogram showing right atrial mass/clot.
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Transthoracic echocardiography (TTE) showed the left ventricular systolic function 40-45% with right atrial mass possibly a clot extending to right atrial appendage measuring 2 cm x 3.1 cm (Figure 2).
Aortic valve short axis and bicaval views of TEE showing right atrial mass at the junction between the SVC and the right atrium.
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Transesophageal echocardiography (TEE) was done for further evaluation of the lesion which showed atrial mass at the conjunction between IVC and right atria (Figure 3).
Coronary angiogram showing coronary cameral fistula between the first septal perforator of LAD and LV and between the RCA and LV.
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Preoperative cardiac catheterization showed no obstructive coronary artery disease, except for coronary cameral fistula (Figure 4).
H and E stain of the excised right atrial mass showing fragments of the myocardium and multiple free floating papillary structures. The outer surface of these papillary structures is lined by endothelial cells. The stroma is fibroelastic with prominent myxoid changes. These findings are consistent with papillary fibroelastoma.
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Surgical excision of the right atrial mass from base of the stalk was done and histopathology of the mass was consistent with PFE (Figure 5).