PMC8787829_01
(A) ECG shows Q-waves in II, III, aVF leads, and left axis deviation, indicating inferior myocardial infarction. (B) A large (59 x 53 mm), heterogeneous mass detected on transthoracic echocardiography (TTE) located in the right atrioventricular groove. (C) Computed tomographic angiography (CTA) shows a spherical, mixed-density mass (5.4 x 5.5 cm) located at the anterior wall of the right atrium. (D) With coronary artery CTA, the proximal right coronary artery is not possible. Contrast filling can be detected in the distal part of the artery. (E) Cardiac MRI manifests a large (5.6 x 5.1 x 5. cm), round, mixed-signal mass located in the right atrioventricular groove. The right atrium and the right ventricle are compressed, and the ejection fractions (EFs) of the left and right ventricles are 36.1 and 40.1%, respectively. (F) The oval, cystic, under epicardium hematoma, is revealed out-punching from the right atrioventricular groove through pericardiotomy. The hematoma was partially incised, and the thrombus and abscess were found and evacuated. (G) The histopathological report demonstrates fibrosis with the additional presence of inflammatory cells. (H) The content was thrombus, with a plethora of neutrophil granulocytes inside.
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F1
Sinus rhythm was present with ECG, which also showed Q-waves in II, III, and aVF and a left axis deviation (Figure 1A). Transthoracic echocardiography (TTE) revealed a large (59 x 53 mm) heterogeneous mass in the right atrioventricular groove (Figure 1B). Computed tomographic angiography (CTA) showed a spherical, mixed-density mass (5.4 x 5.5 cm) located at the anterior wall of the right atrium (Figure 1C). Therefore, the proximal right coronary artery (RCA) could not be clearly visualized due to the presence of the tumor, whereas the distal right coronary artery and all other coronary arteries were patent without the presence of lumen narrowing or significant plaques (Figure 1D). Cardiac magnetic resonance imaging (MRI) manifested a large (5.6 x 5.1 x 5 cm), round, mixed-signal mass located in the right atrioventricular groove, compressed right heart, and ejection fractions (EFs) of the left and right ventricles of 36.1 and 40.1%, respectively (Figure 1E). After resection of the outer layer of the lesion, thrombus-like tissue was found, which was consistent with the diagnosis of hematoma formation caused by rupture of the coronary artery (Figures 1F,G).