An incidental calcified right atrial mass.

Area of Science:

• Cardiology
• Pathology
• Cardiac Surgery

Background:

• Right atrial myxomas are the most common primary cardiac tumors.
• Myxomas can present with diverse symptoms, including incidental findings on imaging.
• Infartction within a myxoma is a rare complication.

Observation:

• A 58-year-old male presented with a mild cough and a 4 cm 'ring opacity' in the right atrium on chest x-ray.
• Transthoracic echocardiogram confirmed a large mass (41 mm x 33 mm) in the right atrium.
• Surgical excision revealed a firm, calcified 4 cm x 3 cm mass.

Findings:

• Pathological examination identified the mass as an old, largely infarcted, and calcified right atrial myxoma.
• Histology showed only minimal viable tumor cells, indicating extensive necrosis.
• This represents the first reported case of an almost completely infarcted atrial myxoma.

Implications:

• This case highlights the importance of considering infarction in the differential diagnosis of atrial masses.
• Complete infarction may alter the typical presentation and growth patterns of atrial myxomas.
• Understanding tumor infarction is crucial for accurate diagnosis and surgical planning of cardiac tumors.