Ann Thorac Surg 2005;79:717
© 2005 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Calcified Mass in the Right Atrium
Vladimiro Vida, MDa,
Alessia Cerutti, MDb,
Gaetano Thiene, MDc,
Giovanni Stellin, MDa,
Ornella Milanesi, MDb,
Cristina Basso, MD, PhDc,*
a Institute of Cardiac Surgery, University of Padua Medical School, Padua, Italy
b Department of Paediatrics, University of Padua Medical School, Padua, Italy
c Institute of Pathology, University of Padua Medical School, Padua, Italy
* Address reprint requests to Prof Thiene, Institute of Pathology, Via A. Gabelli, 61, Padova 35100, Italy
cardpath{at}unipd.it
A 12-year-old asymptomatic child was urgently admitted to the hospital after a calcified mass in the left lower hemithorax was incidentally detected on a plain chest roentgenogram during routine follow-up (Fig 1A, arrow). He had been previously treated for 24 months with chemotherapic agents injected through a permanent central venous line due to stage III non-Hodgkin's lymphoma. No atrial mass was visible by two-dimensional echocardiography 12 months before, at the time of the central venous catheter removal.
A diagnosis of an intracardiac, S-shaped calcified mass, located at the junction between the inferior vena cava and the sinus portion of the right atrium, was achieved by transesophageal two-dimensional echocardiography (Fig 1B, arrow). The calcified mass was successfully removed together with the implantation base with the aid of cardiopulmonary bypass, bicaval cannulation, moderate hypothermia, and cardioplegic arrest (Fig 2A). Postoperative course was uneventful, the child was discharged home, and no atrial mass recurrence was found at a 6-month follow-up.
Surgical pathology examination revealed that the rock-hard mass consisted of abundant calcific deposits in a hyaline stroma and was attached over an otherwise normal myocardium of the right atrial wall (Fig 2B, RAW = right atrial wall; M = mass). All these features are in keeping with a calcified mural thrombus, as a possible consequence of previous long-term central intravenous therapy.
