Comparative analysis of ultrasound manifestations and surgical pathology of right atrial tumors

OBJECTIVE: This study summarizes the echocardiographic characteristics of right atrial tumors by correlating ultrasonographic findings with surgical and pathological outcomes. This correlation aims to enhance the diagnostic accuracy of ultrasound for these lesions. METHODS: A retrospective analysis was performed on 42 patients with a preoperative ultrasound diagnosis suggestive of a right atrial tumor who underwent cardiac surgery at the Department of Cardiovascular Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, from January 2019 to October 2024. The echocardiographic characteristics of these patients were subsequently compared with their surgical and pathological findings. RESULTS: The cohort comprised 42 patients (20 male, 22 female) aged 32 to 87 years (mean 58.8). Surgical pathology identified 23 benign right atrial tumors: 16 myxomas, 4 lipomas, 2 hemangiomas, and 1 leiomyoma. Nine primary malignant tumors were confirmed, consisting of 7 diffuse large B-cell lymphomas and 2 malignant mesenchymal tumor. Two cases were metastatic tumors, and eight were thrombi. Ultrasound correctly diagnosed 17 benign myxomas, with one misdiagnosis, achieving 94% concordance with surgical pathology. Ultrasound also accurately identified two lipomas and one leiomyoma. All seven tumors diagnosed as malignant by ultrasound were pathologically confirmed. A comparison of echocardiographic features between the benign (n = 23) and malignant (n = 11) tumor groups showed statistically significant differences (P < 0.01) in tumor location within the right atrium, shape regularity, border clarity, pedicle presence, mobility, and pericardial effusion. CONCLUSION: Ultrasound accurately diagnoses cardiac myxomas. Benign right atrial tumors typically display a regular morphology, well-defined borders, a pedicle, and high mobility. Malignant tumors, however, are often irregularly shaped, sessile, and adherent to adjacent tissues with indistinct borders; they are also frequently accompanied by pericardial effusion. Echocardiography is the primary diagnostic modality for right atrial tumors. Integrating these specific sonographic features with the patient’s history and clinical presentation substantially improves the diagnostic accuracy of echocardiography for such tumors.