Right atrial tuberculoma: report of a case with complete recovery.

An 18 year old man was admitted with progressively increasing chest pain of one year's duration and palpitation, breathlessness, and oedema of the lower limbs that had lasted for three months. On examination there was ankle oedema; the blood pressure was 90/60 mm Hg and the jugular venous pressure was 7 cm from the sternal angle with prominent V waves and Y descent. The apex beat was easily felt in the 4th LICS at the mid-clavicular line. The first and second heart sounds were unremarkable and a clear early third heart sound was audible over the right sternal border. There were no mumurs. The liver was palpable 4 cm below the costal margin and tender. The spleen was not felt and there was no free fluid in the abdomen. The lungs, central nervous system, and musculoskeletal system were normal. Results of laboratory investigations of blood and urine were normal except for an increased erythrocyte sedimentation rate. The electrocardiogram showed regular sinus rhythm with a rate of 120 beats/min, with no features of atrial or ventricular hypertrophy and normal QRS voltage. The posteroanterior chest radiograph showed a cardiothoracic ratio of 45% with a prominent right atrial shadow and main pulmonary artery. The lung vascular pattern was normal. On cardiac catheterisation the pressure data suggested a restriction to filling of the right ventricle. A right atrial angiogram showed an irregular filling defect in the lower part of the right atrium (fig a). The right ventricular angiogram showed a moderate sized right ventricle with no tricuspid regurgitation. A left heart study including a left ventriculogram yielded normal results. An endocardial biopsy of the right atrial mass was carried out with a bioptome. Examination of the specimen showed much necrotic tissue, with occasional granulomas suggesting tuberculosis. Surgical exploration using cardiopulmonary bypass was undertaken and this showed a firm tumour like mass