Large Right Atrial Mass Uncovered during Routine Echocardiogram for New Onset Atrial Fibrillation

Abstract

Case Report A 64-year-old man with a history of aortic valve replacement 14 years prior presented to the emergency department with new onset atrial fibrillation. He reported two weeks of weakness and fatigue preventing him from completing his work as an apartment manager. N-terminal pro b-type natriuretic peptide serum level was elevated and chest x-ray showed enlarged right atrium with clear costophrenic angles. Transthoracic echocardiogram (Figure A) demonstrated what appeared to be a large 6 cm by 7 cm mass abutting the right atrium without evidence of functional obstruction per doppler flow imaging. Chest CTA (Figure B) revealed a large 10 cm by 8 cm by 7 cm calcified pseudoaneurysm of the aortic root with mass effect on the right atrium in addition to severe coronary artery disease of the RCA and LCx. Patient was referred for nonemergent CT surgery and the following week underwent repair of the aortic root pseudoaneurysm with a bovine pericardial patch, coronary artery bypass grafting, and closure of the left atrial appendage. The patient recovered without complication and was discharged from the hospital 7 days later. Patient returned to work two weeks after surgery and endorsed feeling well at 2 week outpatient clinic followup.