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European Journal of Echocardiography 2005 6(4):286-287; doi:10.1016/j.euje.2004.09.011
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Copyright © 2004, The European Society of Cardiology

An elusive cystic mass in right atrium

Jawed Polad*, Marcel L. Geleijnse and Tjebbe W. Galema

Thorax centre, Erasmus MC, Cardiology Department, Rotterdam, Netherlands

Received 24 September 2004; .

* Corresponding author. Tel.: +31 10 4675717. E-mail: jpolad@doctors.org.uk

A 39-year-old man known to have dilated cardiomyopathy was admitted to hospital with 3-week history of malaise and fever after a holiday in Turkey. Clinical examination was unremarkable apart from general cachexia and clubbing of the fingers. Staphylococcus aureus was grown in blood cultures. A trans-thoracic echocardiogram did not reveal any vegetation on the valves or any intra-cardiac mass (Fig. 1). For better structural visualisation a trans-oesophageal echocardiogram was performed which revealed a big mobile cystic mass within the right atrium attached to inter-atrial septum at the level of foramen ovale (Fig. 2). The patient was treated with appropriate antibiotics and heparin. Two weeks into treatment a repeat trans-oesophageal echocardiogram was performed which revealed total resolution of the mass (Fig. 3). In the absence of any clinical evidence of embolism and normalising inflammatory parameters, it is most likely that the mass represented an infected thrombus. This illustrates the value of trans-oesophageal echocardiography in detecting the abnormalities in atria and inter-atrial septum.


Figure 1
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  		Figure 1 Trans-thoracic echocardiogram prior to treatment.

 


Figure 2
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  		Figure 2 Trans-oesophageal echocardiogram prior to treatment.

 


Figure 3
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  		Figure 3 Trans-oesophageal echocardiogram two weeks into treatment.

 

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This Article
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