PMC9752908_01
Echocardiography showed a large cystic-solid mixed echogenic lesion in the right atrium. Apical four-chamberview (A) and subxiphoid four-chamber view (B) showed that the mass was attached to the right atrial surface of the atrial septum. Ultrasound findings of tricuspid valve orifice (C) andinferior vena cava (D). M = (intracardiac mass).
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F1
Two-dimensional transthoracic echocardiography (2D-TTE, Philips EPIQ CVx-Philips Medical Systems, Andover, MA, USA) revealed mild dilatation of the right atrium, with a predominantly cystic-solid mixed echogenic lesion that was present the right atrium with a rounded shape and a pedicle attached to the right atrium (Figures 1A, B). No apparent obstruction or hemodynamic abnormalities were observed in the Valvular orifice (Figure 1C). No obvious abnormalities were apparent upon sonogram-based examination of the inferior vena cava (Figure 1D).
The RA mass was seen on contrast enhancement ultrasound (CEUS). (A-D) CEUS results showed that in different cardiac cycles, which the solid echo mass in the right atrium tumor revealed high contrast enhancement, and no contrast enhancement is evident in the surrounding anechoic area. M = (intracardiac mass).
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F2
CEUS results revealed high contrast enhancement in the solid echoic mass in the center of the right atrial tumor, while no contrast enhancement was evident in the surrounding anechoic area (Figure 2).
Axial view of chest computed tomography. (A) Chest CT showed low levels of inflammation in both lungs (red arrow). (B) Chest CT also showed a dense patchy shadow in the RA (yellow arrow).
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F3
The patient subsequently underwent chest CT examination, which showed low levels of inflammation in the middle lobe of the right lung, the lower lingual segment of the upper lobe of the left lung, and the lower lobes of both lungs (Figure 3A). In addition, the chest CT scan also exhibited a dense patchy shadow in the right atrium (about 26 mm x 14 mm in size) (Figure 3B).
Surgical and pathological results. The tumor was spherical mass (A) and that was connected to the right atrial side of the right atrial septum under the oval fossa with a small tumor pedicle (B). (C) The ex vivo tumor was black spherical. (D) It can be observed that the yellowish white solid tumor with rough texture is attached to one side of the cyst wall after dissecting the tumor. (E,F) Stained with hematoxylin and eosin (H&E) at 10 magnification: the tumor comprised mature adipocytes with entrapped myocardial cells.
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F4
Intraoperative examination revealed moderate cardiac enlargement, and a spherical mass with a size of about 3.0 cm x 4.0 cm could be seen in the right atrium, the tumor was connected to the right atrial side of the right atrial septum under the oval fossa with a small tumor pedicle (Figures 4A, B). Subsequent dissection thereof resulted in the outflow of a large volume of dark red liquid, after which a solid yellow-white tumor with a rough texture was observed attached to one side of the cyst wall (Figures 4C, D). Postoperative pathological examination via light microscopy revealed large sheets of mature adipocytes interspersed between the myocardium, leading to the diagnosis of a cardiac lipoma (Figures 4E, F).