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An unusual finding in the right atrium
  1. Chee Loong Chow1,2,
  2. Sylvia S M Chen1,
  3. William van Gaal1,2
  1. 1Department of Cardiology, Northern Hospital, Epping, Victoria, Australia
  2. 2Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Chee Loong Chow, Department of Cardiology, Northern Hospital, 185 Cooper Street, Epping, VIC 3076, Australia; dominic.c88{at}


Clinical introduction A 66-year-old asymptomatic patient underwent a routine transthoracic echocardiogram prior to commencement of clozapine, and was found to have a mobile echogenic structure in the right atrium, which was later confirmed on transoesophageal echocardiogram to be adjacent to the insertion of inferior vena cava.

Follow-up cardiovascular MRI (CMR) revealed a mobile, avascular 2.1×2.2 cm2 mass with regular and smooth borders, adjacent to the eustachian valve (Figure 1 panel A: coronal view; online supplementary movie 1). Late gadolinium enhancement (LGE; panel B) demonstrated heterogeneity, and T1-imaging demonstrated mild hyperintensity (panel C). There was no evidence of obstructive haemodynamic compromise.

The mass was subsequently resected, and the histology (H&E staining, magnification ×100) is shown in panel D.

Question The diagnosis of this mass is:

  1. Aberrant liver

  2. Angiosarcoma

  3. Atrial myxoma

  4. Renal cell carcinoma

  5. Thrombus

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  • Contributors All authors have substantial contribution to the conception of the work, acquisition, analysis and interpretation of data.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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