Unveiling a Rare Right Atrial Fibroma: A Multimodal Imaging Approach

A 41-year-old man presented with right heart failure symptoms following a prior Ross procedure and transcatheter pulmonic valve replacement.

Multimodal imaging revealed prosthetic pulmonic valve dysfunction and an incidental right atrial mass. Initial transthoracic echocardiography demonstrated significant prosthetic pulmonic stenosis, while cardiac computed tomography confirmed prosthetic pulmonic valve hypoattenuated leaflet thickening and a homogenous right atrial mass. Cardiac magnetic resonance imaging narrowed the differential of the mass to a benign etiology, and an intracardiac echocardiography-guided biopsy confirmed fibroma.

A literature search revealed that fibromas, let alone right atrial fibromas, in adults are quite rare. This vignette illustrates the essential role of multimodality imaging in diagnosing rare cardiac tumors and guiding clinical management.

Right atrial fibromas are extremely rare in adults, as cardiac fibromas more commonly affect children and usually involve the ventricles. Accurate diagnosis and optimal management rely on a thorough assessment using advanced multimodality imaging techniques.