Korean Circ J.  2011 Feb;41(2):97-100. 10.4070/kcj.2011.41.2.97.

A Huge Mediastinal Organizing Hematoma Causing Reversal of Atrial Septal Defect Shunt Flow

• Kim EK
• Lee SC
• Park SB
• Park S
• Bahng S
• Choe YH
• Sung K

• KMID: 2225142
• DOI: http://doi.org/10.4070/kcj.2011.41.2.97

Abstract

We report a case of a 46-year-old woman who presented with subacute exertional dyspnea and severe hypoxia. A large cystic mass compressing the right side of the heart along with right-to-left atrial shunt flow through an alleged atrial septal defect (ASD) were detected on echocardiography. CT scan of the chest and MRI of the heart revealed a loculated cystic mediastinal mass with hemorrhage measuring 5.5x8 cm compressing the right atrium and ventricle. The patient underwent cyst resection and primary closure of the ASD. This report illustrates a case of an unusual symptomatic pericardial mass compressing the right atrium and ventricle in a patient with an secundum ASD.

Keyword

Mediastinal cyst; Atrial septal defect; Hematoma

MeSH Terms

Anoxia
Dyspnea
Echocardiography
Female
Heart
Heart Atria
Heart Septal Defects, Atrial
Hematoma
Hemorrhage
Humans
Mediastinal Cyst
Middle Aged
Thorax

Figure

• 

  Fig. 1 Initial echocardiogram. Apical four-chamber view is showing an atrial septal defect (A and B). On color doppler echocardiogram, the direction of the shunt flow through the septal defect is shown to be left-to-right.

• 

  Fig. 2 Follow-up echocardiogram. A: in apical four-chamber view, the pericardial cyst is compressing the right side of the heart (*) almost completely. B: contrast echocardiogram demonstrating the pericardial cyst compressing the right atrium and ventricle (*). Cystic mass does not show enhancement of contrast. C: color doppler echocardiogram showing a huge pericardial cyst and an atrial septal defect. The direction of the shunt flow (white arrow) through the septal defect is shown to be right-to-left.

• 

  Fig. 3 Chest CT and MRI of the heart. Coronal view of chest CT (A) shows a cystic lesion in the right pericardial space. A short axis cine image view (B) demonstrates a compressed right ventricle (*) and an intact left ventricle. There is no communication between the mass and the heart. Axial T2-weighted view (C) shows a dark fluid-fluid level within the dependent portion of the mass.

• 

  Fig. 4 Intra-operative photograph of the pericardial cyst (patient's head is on the left side).

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