ABSTRACT
Background Right atrial (RA) masses often pose a dilemma in accurate diagnosis and management. We describe a challenging case of a large mobile RA mass in a febrile cancer patient. Case A 36-year-old female with newly diagnosed breast cancer on chemotherapy for 4 months via Port-A-Cath presented initially with COVID-19 pneumonia but continued to have persistent fever and dyspnea. A CT of the chest ruled out pulmonary embolism but showed an incidental RA mass. Echocardiography confirmed a large (2.7 x 1.6 cm), pedunculated mobile mass in the RA, attached to the free wall near the Eustachian valve (Fig.1). For a suspected thrombus, anticoagulation was initiated and a percutaneous thrombectomy using AngioVac was attempted. The mass was tightly attached to the atrial wall and too large to suction, resulting in only partial extraction of multiple tumor-like masses. Decision-making In addition to catheter-related thrombus and COVID-19 infection-related thrombus in transit, possibilities of myxoma, metastasis and fungal vegetation were considered due to its atypical features. A week later, pathology confirmed the diagnosis of an organized thrombus. Surgery was deferred and instead a repeat AngioVac using a larger aspiration catheter successfully aspirated the entire RA mass without complications. Conclusion Percutaneous aspiration of RA masses can prove to be of both diagnostic and therapeutic use, especially in high-risk patients. It can help avoid invasive surgical intervention in clinical dilemmas. [Formula presented]Copyright © 2023 American College of Cardiology Foundation