PMC10129422_01
Transthoracic echocardiogram showing RV mass. (a) Parasternal short axis view demonstrates the mass (white arrow) extending from the undersurface of the tricuspid annulus and traversing the pulmonic valve. (b) Redemonstration of RV mass (white arrow) in the parasternal long axis view. Abbreviations: RV: right ventricle.
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fig1
A mobile, pedunculated mass was seen extending from the undersurface of the tricuspid annulus and traversing the pulmonic valve into the main pulmonary artery with mild right ventricular (RV) dilatation and hypokinesia (Figure 1). A gated computed tomographic angiography (CTA) of the chest confirmed the RV mass with no evidence of pulmonary embolism or extra-cardiac extension (Figure 2 and Video SF1).
Gated computed tomographic angiography of the chest showing the mass in the RV (a) traversing the pulmonic valve into the main pulmonary artery. (b) Abbreviations: RV: right ventricle.
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fig2
A gated computed tomographic angiography (CTA) of the chest confirmed the RV mass with no evidence of pulmonary embolism or extra-cardiac extension (Figure 2 and Video SF1). On cardiac magnetic resonance imaging (CMR), the mass was hypointense on the T1 sequence, had poor uptake on first-pass perfusion, and a heterogeneous uptake was on late gadolinium enhancement, which reflective of a benign tumor like myxoma (Figure 4 and Video SF2).
Transesophageal echocardiographic views of the RV mass. (a) Shows trans-gastric views which demonstrates the attachment of the mass to the undersurface of tricuspid annulus adjacent to the anterior tricuspid leaflet (white arrow). (b) Shows the short axis view where the RV mass (white arrow) is visualized traversing the pulmonary valve.
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fig3
The trans-gastric views demonstrated the attachment of the mass to the undersurface of the tricuspid annulus adjacent to the anterior tricuspid leaflet via a narrow stalk measuring 1.4 cm and extending 3-4 cm into the main pulmonary artery (Figure 3).
Cardiac magnetic resonance imaging shows RV mass. (a) shows RV mass, which is hypointense on T1 sequence, isointense on T2 (b), (c) shows poor first pass perfusion, and (d) shows heterogeneous uptake on late gadolinium enhancement. Abbreviations: RV: right ventricle.
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fig4
On cardiac magnetic resonance imaging (CMR), the mass was hypointense on the T1 sequence, had poor uptake on first-pass perfusion, and a heterogeneous uptake was on late gadolinium enhancement, which reflective of a benign tumor like myxoma (Figure 4 and Video SF2).
Intraoperative view shows a soft and friable red gelatinous mass being retrieved from the right atrium.
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fig5
Intraoperatively, the tumor was found to be soft and friable, extending into the PA, requiring dissection of the main PA to ensure complete retrieval of the mass into the right atrium (Figure 5).