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Right atrial masses are rare, challenging to diagnose, and potentially life-threatening with high mortality if untreated.
This case highlights the importance of multimodality imaging and histological examination to differentiate a rare calcified right atrial mural thrombus from metastatic disease in a patient with cerebral lymphoma.
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Multimodality imaging aids RA mass characterization in lymphoma; extends sparse reports but leaves diagnostic algorithms open.
Right atrial (RA) masses are rare, challenging to diagnose, and potentially life-threatening with high mortality if untreated. We present a patient presenting with diffuse large B-cell lymphoma in the brain that was incidentally found to have a large RA mass. For a better definition of the RA mass, extensive workup using multimodality imaging including chest computed tomography, transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance imaging, and left heart catheterization was warranted. The imaging demonstrated a large RA mass extending through the tricuspid valve into the right ventricle and superior and inferior vena cava without a mobile component. The mass was then successfully resected, and further histology examination was performed to rule out lymphoma and rare subtypes of diffuse large B-cell lymphoma. The comprehensive workup proved the RA mass to be a calcified thrombus rather than a direct metastatic spread of lymphoma.
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Fath et al. (2021) studied this question.
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