Aneurysm of the right atrial appendage in an elderly patient

A 72-year-old male patient presented with a complaint of pain in both legs during short walks of less than 50 meters. Physical examination showed weak arterial pulses in both lower extremities. Electrocardiographic and telecardiographic evaluations were normal. A previous abdominal ultrasonography examination performed for abdominal pain showed an abdominal aortic aneurysm. Coronary angiography findings were normal; however, peripheral angiography showed an abdominal aortic aneurysm and extensive critical bilateral peripheral artery disease. Transthoracic echocardiography disclosed an aneurysmal structure neighboring the right atrium. Transesophageal echocardiography demonstrated a 30x18-mm chamber suggestive of a right atrial appendage aneurysm. Cardiac magnetic resonance imaging confirmed the presence of the right atrial appendage aneurysm, 25x15 mm in size, over the tricuspid valve. The neck of the aneurysm was 11 mm. The patient underwent surgery which included grafting of the abdominal aorta and aortobifemoral bypass. He was discharged uneventfully on oral anticoagulant therapy.