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Ping-Pong Ball, Tumor or Thrombus in the Right Atrium? A Case Report
Stephanie Ghaleb1, Bryant Roosevelt2, James Cnota1
11 Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Differentiating right atrial masses like tumors and thrombi can be challenging. This case highlights how a large right atrial thrombus was initially misdiagnosed, emphasizing the need for definitive pathology in complex cardiac mass management.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Right atrial masses, commonly tumors and thrombi, pose diagnostic challenges.
- Noninvasive imaging can be deceptive in differentiating cardiac masses.
- Clinical judgment and emergency context are crucial for management decisions.
Abstract:
Tumors and thrombi are the most common cardiac masses of the right atrium. The use of noninvasive imaging to differentiate between the two can be deceiving, and the clinical judgment of a cardiologist and the emergency of the situation should be partnered to decide on the next step of the management. We present the case of a 29-year-old lady who was receiving neoadjuvant treatment for her rhabdomyosarcoma and was incidentally found to have a very large, very mobile right atrial mass that was protruding in the right ventricle with each cardiac cycle along with findings of a small segmental right lower lobe pulmonary embolism. Along with noninvasive imaging, frozen section analysis procured the wrong diagnosis, and the mass was ultimately found to be a right atrial thrombus on definite pathology review. Exact management of right atrial masses continues to be not well delineated, and when in doubt, final diagnosis might need to be "a posteriori" and based on the treatment response.
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