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European Journal of Echocardiography 2008 9(1):95-96; doi:10.1016/j.euje.2007.03.029
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org.

Diagnosis of right atrial mass by perioperative transesophageal echocardiography

Cassiano Moro1, Andrew Klein1,*, Kumud Dhital2 and Julian Gooi2

1 Department of Anaesthesia, Papworth Hospital NHS Trust, Papworth Everard, Cambridge CB23 3RE, UK
2 Department of Cardiothoracic Surgery, Papworth Hospital NHS Trust, Papworth Everard, Cambridge CB23 3RE, UK

Received 9 February 2007; accepted after revision 11 March 2007; online publish-ahead-of-print 10 May 2007.

* Corresponding author. Tel: +44 7971687764. E-mail address: andrew.klein{at}papworth.nhs.uk


  Abstract

A 67-year-old lady presented with shortness of breath, and was found to have severe triple vessel disease by coronary angiography. Transthoracic echocardiography (TTE) was reported as normal. However a large cystic mass was unexpectedly found in the right atrium by intra-operative transesophageal echocardiography (TOE). This mass was attached to the anterior wall, just by the inter-atrial septum. Flow was demonstrated within the mass by colour flow doppler. The right atrium was opened and the mass excised during cardio-pulmonary bypass. A right coronary artery aneurysm was diagnosed, which was confirmed on histopathological examination. The importance of intra-operative TEE in demonstrating new findings and changing management is highlighted. Coronary artery aneurysm may predispose to embolism or thrombosis if untreated, and may not be seen on angiography or TTE, as in this case.

Keywords: Right coronary artery; Aneurysm; Transesophageal echocardiography


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