PMC8559658_01
A, chest x-ray showing possible bronchiectasis and left lung lower lobe collapse (black arrow). B, pulmonary CTA showing no evidence of pulmonary embolism. C, transesophageal echocardiography showing the mass protruding through tricuspid valve
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F1
In para-clinical evaluation, on chest x-ray (figure 1A) and chest computed tomography (CT) scan, there was evidence of bronchiectasis and left lung lower lobe collapse. Pulmonary computed tomography angiography was done for the patient which showed no evidence of pulmonary embolism (figure 1B). One lobe of it was perforating the RA wall and protruding to RV outflow tract from tricuspid valve (figure 1C and supplementary video file 1).
A, Macroscopy of the tissue during surgery. B, Immunohistochemistry showing CD 31 staining. C, Immunohistochemistry showing CD 34 staining
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F2
The patient had severe symptoms and so surgical consult was done for the patient to remove the mass (figure 2A). On pathological evaluation, there was neoplastic tissue composed of fasciculated spindle cells being highly CD31 positive (figure 2B) and CD 34 positive with high Ki67 proliferation index (figure 2C). CMR showed a non-homogenous mass around RA and RA appendage with a size of 64x14mm (figure 3 and supplementary video file 2).
T2 Weighted STIR image shows high signal intensity mass at lateral part of RA wall (white arrows).
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F3
CMR showed a non-homogenous mass around RA and RA appendage with a size of 64x14mm (figure 3 and supplementary video file 2).