A 51-year-old patient with a history of acute coronary syndrome treated with a stent 8 years earlier attended the emergency department with a complaint of chest pain. Chest X-ray showed condensation in the periphery of the right lung (Fig. 1A). A chest computed tomography (CT) scan detected a filling defect in the right atrium (RA) and another in the intermediate artery (Fig. 1B–D). A subpleural pulmonary opacity of the right lung was interpreted as a small pulmonary infarction. Transthoracic echocardiography confirmed a 35mm moving mass in the RA with two implantation sites. A diagnosis of myxoma or thrombus-in-transit in the RA complicated by pulmonary embolism was suggested and, given the high risk of massive pulmonary embolism, an urgent surgical intervention was performed that finally revealed a soft right atrial thrombus.
(A) Posterior anterior chest X-ray showing condensation in the periphery of the right lung, corresponding to a pulmonary infarction (arrow). (B, C) Axial (B) and sagittal (C) chest CT images showing a mass in the right atrium (arrows). (D) Axial CT image of the chest in which a filling defect is seen in the intermediate artery (arrow).
Cardiac thrombi particularly affect the left atrium, although they have also been described in the RA where they usually correspond to thrombi-in-transit and are accompanied by a high mortality rate. Myxomas are the most common primary cardiac tumors and 80%–90% affect the left atrium. RA myxomas can simulate a thrombus-in-transit, embolize the pulmonary arteries, and cause pulmonary infarctions. An RA thrombus-in-transit can simulate a cardiac myxoma in imaging techniques.1
Conflict of InterestsThe authors state that they have no conflict of interests.
Please cite this article as: Gorospe Sarasúa L, Ayala-Carbonero AM, Mirambeaux-Villalona RM. Masa en aurícula derecha y embolismo pulmonar: ¿trombo en tránsito o mixoma? Arch Bronconeumol. 2021;57:435.
