PMC8765037_01
A 12-lead electrocardiogram shows sinus tachycardia with right axis deviation, nonspecific T-wave abnormalities in the inferior leads, and nonspecific QRS changes in the chest leads.
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His electrocardiogram (ECG) showed sinus tachycardia with right axis deviation, non-specific T-wave abnormalities in the inferior leads and non-specific QRS changes in the chest leads (Fig. 1).
Anterior posterior view of plain chest X-ray shows loculated (arrows) pleural effusion at the lower right heart boarder.
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A plain chest X-ray showed a small loculated right pleural effusion, attached to the right heart border (Fig. 2).
Continuous wave Doppler across the right atrium shows significant obstruction with a peak gradient of 6.8 mmHG.
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Panels A-C: Axial (A), 4-chamber (B), and sagittal (C) steady-sate free precession (SSFP), CMR images at presentation shows a large right atrial mass; Panels D-F: Axial (D), 4-chamber (E), and sagittal (F) SSFP CMR images during follow-up after 5 months shows significant regression in mass size.
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Cardiac magnetic resonance (CMR) showed a large homogenous mass, measuring 25 x 48 mm along the lateral, inferior and inferomedial walls of the right atrium with a homogenous signal demonstrating a significant obstruction (Fig. 4, Panels A-C). After five months, a repeated TTE and CMR showed regression of the mass to less than 10% of its original size (Fig. 4, Panels D-F).
Hematoxylin and eosin stain of abdominal wall tissue biopsy at 20x magnification shows non-necrotizing caseating granuloma within a background of fatty tissues, with a negative AFB smear from the tissue sample.
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While awaiting culture results, we took a biopsy from the abdominal collection wall, showing caseating granuloma (Fig. 5).
Steady-sate free precession (SSFP) CMR images after 4 years shows near-complete resolution of the right atrial mass.
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A repeated CMR at four years showed a near-complete resolution of the mass (Fig. 6).