Giant Right Atrial Mass Following Surgical Aortic Valve Replacement

Figure 1 – Transthoracic echocardiography: giant eco-dense mass occupying the entire right atrium (Panel A) and severely limiting tricuspid valve inflow (Panel B). Atrial wall and visceral pericardium (arrows) A 75-year-old man underwent elective biological aortic valve replacement. Two weeks after surgery, transthoracic echocardiography (TTE) showed a small pericardial effusion. On the following day, the patient suffered from syncope. A repeated TTE revealed a “giant” echo-dense mass (90x80 mm) occupying the entire right atrium and severely limiting tricuspid valve inflow. Although the initial differential diagnosis included the development of an intracavitary process, the rapidly-growing mass with a characteristic echo-lucent layer at its atrial aspect (consistent with the atrial wall and visceral pericardium) (arrows) led to the final diagnosis of a pericardial hematoma mimicking a huge atrial mass. Emergency surgical exploration confirmed the diagnosis. Author contributions Acquisition of data: Bastante T. Analysis and interpretation of the data: Bastante T. Writing of the manuscript: Bastante T, Alfonso F. Critical revision of the manuscript for intellectual content: Bastante T, Alfonso F. Supervision / as the major investigador: Alfonso F.