Varix of the right atrium

Area of Science:

• Cardiovascular Pathology
• Surgical Pathology

Background:

• Incidental cardiac masses require thorough evaluation to determine etiology and management.
• The fossa ovalis is a common site for cardiac anomalies and masses.

Observation:

• A 68-year-old female presented with an asymptomatic 3.0 x 2.4 cm cystic cardiac mass.
• Imaging revealed a calcified nodule attached to the right atrial rim of the fossa ovalis.
• Surgical exploration identified a pedunculated, dark bluish mass within the right atrium.

Findings:

• Histopathology showed a unilocular cyst lined by endothelium with fibrin clots and dystrophic calcification.
• Immunohistochemistry was positive for CD34 (hematopoietic progenitor cell antigen).
• The final diagnosis was consistent with a cardiac varix.

Implications:

• Cardiac varices should be considered in the differential diagnosis of cystic cardiac masses, particularly those near the fossa ovalis.
• Accurate diagnosis is crucial for appropriate patient management and surgical planning.
• This case highlights the importance of integrating imaging, surgical, and pathological findings for diagnosing rare cardiac conditions.