Tumor renal con extensión al atrio derecho a través de la vena cava inferior: reporte de caso / Renal tumor with extension to the right atrium through the inferior vena cava: case report

Resumen El presente articulo describe un caso clínico de una paciente con un ''trombo tumoral''. Estos son tumores que se extienden desde el órgano afectado hasta el atrio derecho, por la vena cava inferior. Hasta el 10 % de los tumores descritos pueden alcanzar la vena cava inferior y el 1 % de estos llegan a atrio derecho. El carcinoma de células renales es el más frecuente en producir este cuadro. El objetivo del articulo es mostrar que es fundamental realizar un adecuado diagnóstico diferencial, ya que existen diferentes procesos tumorales que pueden causar un ''trombo tumoral'' y diferentes causas de masas en el atrio derecho. La clínica de los pacientes con este cuadro será por obstrucción de la vena cava. El diagnóstico se realiza con estudios de imágenes, ultrasonido (US), ecocardiograma, tomografía axial computarizada (TAC) y resonancia magnética. El manejo debe de ser quirúrgico, sin embargo, presenta pronóstico desfavorable, en algunos casos se puede resecar el tumor primario y extraer la masa que ha invadido la vena cava inferior.

Abstract: This article describes a clinical case of a patient with a 'tumoral thrombus''. These are tumors that extend from the affected organ to the right atrium, through the inferior vena cava. Up to 10% of the tumors described can reach the inferior vena cava and 1% of these reach the right atrium. Renal cell carcinoma is the most common to produce this condition. The objective of the article is to show that it is essential to carry out an adequate differential diagnosis since there are different tumor processes that can cause a ''tumoral thrombus'' and different causes of masses in the right atrium. The symptoms of patients with this condition will be caused by the obstruction of the vena cava. The diagnosis is made with imaging studies, ultrasound (US), echocardiography, computerized axial tomography (CT) and magnetic resonance imaging. The management must be surgical, however it has an unfavorable prognosis, in some cases the primary tumor can be resected and the mass that has invaded the inferior vena cava removed.

A new right atrial mass following cardiopulmonary bypass mimicking a thrombus

This report describes a patient with severe mitral stenosis who underwent mitral valve replacement. After completion of cardiopulmonary bypass, an unexpected finding of a right atrial mass was noticed on transesophageal echocardiography. The actual finding, possible differential diagnosis, and the management strategy are discussed.

A Case of Vasculo-Behçet Disease Diagnosed by Right Atrial Mass and Inferior Vena Cava Thrombosis / 日本心臓血管外科学会雑誌

We report a rare case of 16-year-old boy who was given a diagnosis vasculo-Behçet disease after removing a right atrial thrombus. He was admitted to our hospital with abdominal pain and fever. He was underwent appendectomy for suspected appendicitis, but the appendix was normal. Additional image examinations revealed a mobile right atrial mass and inferior vena cava thrombosis, and the patient was sent to reoperation urgently to prevent pulmonary embolism. Surgery revealed the mass to be a thrombus. Vasculo-Behçet disease was diagnosed based on the patient's history and examination data. He was discharged on the 17th postoperative day. Cardiac mass excision should be immediately considered in such cases, and the differential diagnosis of Behçet disease was important for this case.

Prominent Crista Terminalis in Patients with Embolic Events

A prominent crista terminalis is a normal anatomic variant which consist of thick muscular bridge within the right atrium. However, it could be often misdiagnosed with an abnormal mass on the transthoracic echocardiography. The case report presented here, describe the findings of transthoracic echocardiography that suggested a right atrial mass in patients with pulmonary embolism. However, subsequent transesophageal echocardiography and cardiac computed tomography/magnetic resonance imaging differentiated a true right atrial mass from a prominent crista terminalis.

A Case of Right Atrial Mass Associated With Hepatocellular Carcinoma / 영남의대학술지

Right atrial metastasis occurs in 1 to 4% of patients with hepatoma. and the extention to intracavitary or metastasis of tumor as a large mass rare. However, the high risk of progressive heart failure and sudden death from the tricuspid valve obstruction necessitates prompt diagnosis of intracavitary extension, and adequate intervention is needed to prolong a patient's life. A 49 year-old female was referred to our hospital for further evaluation of a liver mass, which was identified at a local clinic. The liver mass was confirmed as hepatocellular carcinoma with CT and celiac angiographic finding. She was treated with transarterial chemoembolization. Thirty-four months after discharge, a low density right atrial mass was noted incidentally with chest computed tomography while investigating massive right pleural effusion for possible pulmonary metastasis. Echocardiography showed a huge inhomogenous echogenic mass at the right atrium. The present report describes a case of primary hepatocellular carcinoma with a intracavitary cardiac mass detected with two dimensional echocardiography.

Two Cases of Chiari Network

A network of strands (Chiari Network) in the right atrium with attachments extending from the crista terminalis to eustachian valve and thebesian valve or sometimes to the floor of the right atrium in the region of the opening of the coronary sinus. While this congenital remnant is seldom clinically important, this membranes have been reported as site of thombus formation, and hence potential etiologies of pulmonary emboli as well as a source of entrapment of a right-heart catheter and arrhythmia. We report two cases of right atrial mass-like chiari form network incidentally detected by transthoracic echocardiography (TTE) and confirmed by transesophageal echocardiography (TEE).