case_images: PMC11807290_01
case_images: A: Large pouch connected to the right atrium with a hypointense lesion seen at its posterior segment (arrow). B: Suspected communication between the RCA and the previously described pouch (arrow).. RCA: right coronary artery, RA: right atrium, RV: right ventricle
case_images: cureus-0017-00000077218-i01.jpg
case_images: PMC11807290_01_cureus-0017-00000077218-i01.jpg
case_images: FIG1
case_images: A large outpouching is noted related to the right atrium lateral wall (Figure 1A) measuring 51x43x64 mm in maximum axial and cranio-caudal dimensions (anterior-posterior x transverse x cranio-caudal), connected to the right atrium through a wide neck measuring 3x2.1 cm. Suspected communication is seen between the proximal part of the RCA and the outpouching (Figure 1B).
case_images: Multi-sequence CMR imaging characterizes the aforementioned lesion. A: T1WIs reveal isointensity (arrow). B: T2WIs depict hypointensity (arrow). C: The absence of signal dropout on FS WIs (arrow). D: No contrast uptake in perfusion images (arrow). E and F: EGE and PSIR images show a dark signal suggesting thrombosis within the lesion (arrow).. CMR: cardiac magnetic resonance, TSE: turbo spin echo, EGE: early gadolinium enhancement, PSIR: phase-sensitive inversion recovery, T1WI: T1-weighted image, T2WI: T2-weighted image, FS WI: fat-suppressed image
case_images: cureus-0017-00000077218-i02.jpg
case_images: PMC11807290_01_cureus-0017-00000077218-i02.jpg
case_images: FIG2
case_images: T1WIs, a hypointense signal in T2WIs, no signal drop in fat suppression images, no contrast uptake in perfusion images with a dark signal with no significant enhancement in late gadolinium inversion recovery, and phase-sensitive inversion recovery images suggesting thrombosis (Figure 2). The presence of a thrombus within the outpouching may be clinically significant, potentially increasing the risk of embolization and related complications.
case_images: Late gadolinium enhancement inversion recovery image shows transmural scarring (arrow) along inferior segments (RCA territory).. RCA: right coronary artery
case_images: cureus-0017-00000077218-i03.jpg
case_images: PMC11807290_01_cureus-0017-00000077218-i03.jpg
case_images: FIG3
case_images: A: Faint wall calcifications were observed within the aneurysm on non-contrast images. B: Communication with the RCA was demonstrated on MIP sagittal images (arrow).. RCA: right coronary artery, MIP: maximum intensity projection
case_images: cureus-0017-00000077218-i04.jpg
case_images: PMC11807290_01_cureus-0017-00000077218-i04.jpg
case_images: FIG4
case_images: This outpouching is seen connected to both the proximal and distal thirds of the right coronary artery as shown in Figure 4.