[Large right atrial aneurysm: rare cause of recurrent pulmonary embolism]

Case report on a 72 year old female patient presenting with collapse and progressive dyspnea. X-ray of the chest showed a marked enlargement of the heart extending to the right. Echocardiography revealed an impressive displacement of the heart chambers to the left caused by a large aneurysm (11 x 5 x 5 cm) located anteriorly and medially from the right heart communicating with the right atrium. Pronounced compression of the basal part of the right ventricle was present. Within the aneurysmatic cavity several highly mobile thrombi and extensive spontaneous echo contrast were demonstrated. On magnetic resonance imaging and right heart angiocardiography the aneurysm was visualized as well. Coronary angiography revealed a marked curved displacement of the right coronary artery to the left side. Perfusion lung scanning suggested bilateral segmental pulmonary embolism proven by digital substraction angiography. With long-term oral anticoagulation the patient remained symptom-free during follow-up of now more than four years.