PMC3634252_01
(a) Chest X-ray, anteroposterior projection showing severe cardiomegaly and right atrial enlargement (b) Postoperative chest X-ray, anteroposterior projection showing decrease in cardiomegaly
APC-6-68-g001.jpg
PMC3634252_01_APC-6-68-g001.jpg
F1
He was then referred for a chest X-ray [Figure 1a] that showed significant cardiomegaly and therefore an echocardiogram was obtained. The chest X-ray [Figure 1b] performed following surgery showed significant reduction in cardiac size.
(a) Apical four chamber view showing a giant right atrium (RA), tricuspid valve is normal (arrow) (b) Post operative echocardiogram showing significant reduction in right atrial size and a small pericardial effusion behind the right atrium (arrow)
APC-6-68-g002.jpg
PMC3634252_01_APC-6-68-g002.jpg
F2
This showed a giant right atrial aneurysm (7 x 6 cm) [Figure 2a]. An echocardiogram [Figure 2b] performed prior to discharge showed significant reduction in the right atrial size, trivial tricuspid regurgitation, and a small pericardial effusion.
(a) Anteroposterior view of cardiac magnetic resonance imaging showing a giant right atrial aneurysm (b) Axial view showing a giant right atrial aneurysm
APC-6-68-g003.jpg
PMC3634252_01_APC-6-68-g003.jpg
F3
These findings were later confirmed by a cardiac magnetic resonance imaging (MRI) [Figures 3a and 3b].
(a) Giant right atrial aneurysm with paper-thin wall noted at the time of surgery (b) Excised right atrial aneurysm showing pectinate muscles, tan-pink colored surface glistening with several pinpoint to larger petechiae and paper-thin walls
APC-6-68-g004.jpg
PMC3634252_01_APC-6-68-g004.jpg
F4
A giant thin-walled aneurysm of the entire free wall of right atrium was noted [Figure 4a]. Histopathological examination of the resected atrial tissue showed paper-thin walls [Figure 4b], and the pathological features included interstitial fibrosis and endocardial thickening with no evidence of thrombosis.