case_images: PMC9684316_01
case_images: Images of first hospitalization and recurrence of right atrial mass. (A) The first echocardiography revealed a right atrial mass. (B) Pathological image of right atrial mass: a small number of platelets and inflammatory exudates. (C) Echocardiography at 10 days after operation showed that the right atrial mass disappeared. (D) Right atrial mass revisited (Less than one month after surgery) White arrows represent thrombus.
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case_images: PMC9684316_01_fcvm-09-1066065-g001.jpg
case_images: F1
case_images: It showed a long oval moderate echo mass in the right atrium with a length of about 5.29 cm and a less smooth surface, which seemed to be pedicled attached to the right atrioventricular orifice of the inferior vena cava (Figure 1A). The pathological examination of the extract showed fibrinoid necrosis (Figure 1B), in which a small number of platelets and inflammatory exudates were seen, no obvious tumor cell components were found, and the total volume was 6 cm x 2 cm x 1.5 cm. Ten days after surgery, the symptoms were significantly improved, no abnormal mass-like echo was detected in the cardiac cavity by echocardiography (Figure 1C). The right atrial mass was revisited (3.41 cm x 0.81 cm, Figure 1D).
case_images: Echocardiography during the second hospitalization and follow-up period. (A) Right atrial mass became less after a week of anticoagulation. (B) Right atrial mass disappeared completely after 2 weeks of bridging anticoagulant therapy. (C) Echocardiography showed no right atrial thrombus (Follow-up period).
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case_images: PMC9684316_01_fcvm-09-1066065-g002.jpg
case_images: F2
case_images: After a week of anticoagulation therapy, the patient's symptoms such as dyspnea were significantly improved, and D-dimmer decreased to 1.18 mg/L, and the right atrial mass became smaller (2.66 cm x 1.56 cm) (Figure 2A) and pulmonary arterial systolic pressure from 37 mmHg decreased to 29 mmHg, anticoagulant therapy had an immediate effect, which also confirmed the possibility of right atrial thrombosis. After 2 weeks of bridging anticoagulant therapy, echocardiography showed that the right atrial mass disappeared completely (Figure 2B), and the patient was discharged from the hospital. Warfarin was used to continue the anticoagulant therapy, INR2-3 was maintained, during follow-up, echocardiography and pulmonary ventilation and perfusion imaging showed significant improvement in both right atrial thrombosis and pulmonary embolism (Figures 2C, 3B).
case_images: Pulmonary ventilation and perfusion imaging before and after treatment. (A) Pulmonary embolism was confirmed by pulmonary ventilation and perfusion imaging. (B) Pulmonary ventilation and perfusion imaging was normal (Follow-up period).
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case_images: PMC9684316_01_fcvm-09-1066065-g003.jpg
case_images: F3
case_images: Then we chose pulmonary ventilation and perfusion imaging, confirming pulmonary embolism and right atrial thrombosis (Figure 3A). Warfarin was used to continue the anticoagulant therapy, INR2-3 was maintained, during follow-up, echocardiography and pulmonary ventilation and perfusion imaging showed significant improvement in both right atrial thrombosis and pulmonary embolism (Figures 2C, 3B).