Kerala Heart Journal -Anurag

Case report

Kerala Heart J  2016; 6(2):xx-xx. 
 

RIGHT ATRIAL MASS IN ENDOMYOCARDIAL FIBROSIS



Anurag Bahekar1, Varghese George1, George Koshy1, K.Venugopal1, Jacob Therakathu2

1: Department of Cardiology, 2: Department of Radiology, Pushpagiri Medical College, Tiruvalla, Kerala



Corresponding author

Dr Anurag Bahekar

Senior Resident

Department of Cardiology

Puspagiri Institute of medical sciences,  Thiruvalla, Kerala


Case report

 

62- year old lady, presented with dyspnea and abdominal distension. ECG showed atrial flutter.

2D Echo showed: -

1.      Obliteration of RV cavity

2.      Dilated RA

3.      Mass attached to RA free wall

4.      Concentric LVH

5.      Mild TR with mild PAH

6.      Moderate pericardial effusion

7.      LV diastolic dysfunction. Findings were consistent

with RV endomyocardial fibrosis.

Figure 1




Discussion:

         Cardiac MRI was planned for evaluation of RV EMF and the RA mass


Figure 2. RV apex obliteration seen in SSFP (Steady State Free Precession)



Figure 3.RV apex obliteration with RA mass in SSFP.




Figure 4 &5.Diffuse sub-endocardial enhancement of RV with Gadolinium confirms RVEMF



Figure 5 . Short axis LGE





Figure 6 - 4 chamber LGE (TI600)


TI-600 protocol RA mass appears heterogeneously black s/o thrombus. (Some areas showing enhancement due to chronic nature of thrombus)



Learning Points:

Cardiac MRI is one of the non-invasive confirmatory investigations in diagnosis of RVEMF and Cardiac Masses. Present case highlights the importance of delayed gadolinium enhancement in the diagnosis of RVEMF and cardiac thrombus.



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