Kosin Med J.  2021 Jun;36(1):40-43. 10.7180/kmj.2021.36.1.40.

Right Atrial Blood Cyst Mimicking a Vegetative Mass

• Lee SH
• Choi JH

• KMID: 2517224
• DOI: http://doi.org/10.7180/kmj.2021.36.1.40

Abstract

A 79-year-old woman presented to another hospital with complaints of right leg pain. Computed tomography and magnetic resonance imaging of the spine was performed in the other hospital, which showed an abscess in the right iliacus muscle. She was referred to our hospital because of a mass in the right atrium on echocardiography. Inflammatory markers were elevated, and Staphylococcus aureus were identified in blood cultures. Transthoracic echocardiography revealed a shaggy mass in the right atrium that resembled vegetation. Transesophageal echocardiography showed a large cystic mass with a hyperechoic lesion. After surgery, biopsy results indicated that it was a myxoid mass with cystic changes.

Keyword

Bacteremia; Cysts; Echocardiography; Endocarditis

Figure

• 

  Fig. 1 (A) TTE in the parasternal RV inflow view showing a shaggy-appearing mass. (B) TTE in the subxiphoid view, showing a mass with color Doppler. (C) TEE shows a large hypoechoic mass and shaggy-appearing mass. (D) A patent foramen ovale is seen on TEE. TTE, transthoracic echocardiography; RV, right ventricular; TEE, transthoracic echocardiography

• 

  Fig. 2 Heart CT image showing a 2.5 cm mass arising from the interatrial septum of the RA. CT, computed tomography; RA, right atrium

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  Fig. 3 (A) Gross findings of the resected RA mass. The cystic mass shows a translucent cystic wall without a solid nodule. The pedicle of the cystic mass is identified (arrow). (B) Microscopic examination of the resected specimen. A. At low magnification, the cystic wall shows myxoid changes in the surface aspect and is supported by a fibromuscular wall (H-E stained, x40). (C) At a high-power view (x400), the cystic wall appears composed of the flat surface epithelium and subepithelial myxoid stroma (flat surface epithelium; red arrow, myxoid stroma; star). (D) The surface epithelium and stellate or spindle-shaped stromal cells appear focally positive for CD34 which was often positive in myxoma10. RA, right atrium; H-E, hematoxylin and eosin

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