Right Atrial Cardiac Fibroma Mimicking Eustachian Valve Endocarditis in Neutropenic Sepsis

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Right atrial cardiac fibroma with neutropenic sepsis (n=1). Intervention: Percutaneous aspiration followed by elective surgical resection. Primary outcome: Definitive histopathologic diagnosis and surgical resection of right atrial mass.

Q: What does this research mean for the field?

Right atrial cardiac fibromas can mimic infective endocarditis or thrombus in septic immunocompromised patients, with procedural resistance during percutaneous aspiration providing functional evidence of low embolic risk. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Meagan E. Prescott; Brittany A. Zwischenberger; Gerald S. Bloomfield; Fawaz Abdulaziz M. Alenezi; John DeMis; Michael Cosiano; Abigail Hitt; Larissa M. Lushniak; Nishant P. Shah

doi:10.1016/j.jaccas.2026.109868

November 1, 2026JACC Case ReportsOpen Access

Right Atrial Cardiac Fibroma Mimicking Eustachian Valve Endocarditis in Neutropenic Sepsis

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Key result

Percutaneous aspiration failure safely defers surgery for ~2 months before right atrial fibroma resection.

n=1

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY 4.0

Why the study?

Managing an undifferentiated right atrial mass in a septic, immunocompromised patient is challenging when imaging and microbiologic findings are discordant, and evidence guiding the management of indeterminate right atrial masses is limited.

Key Points

To describe the clinical management and diagnostic ambiguity of an indeterminate right atrial mass in an immunocompromised patient with neutropenic sepsis.
Case report of a 51-year-old kidney transplant recipient with neutropenic sepsis and an indeterminate right atrial mass (N=1).
Multimodality evaluation performed via transesophageal echocardiography and cardiac magnetic resonance imaging, followed by attempted percutaneous aspiration and subsequent elective surgical resection.
Transesophageal echocardiography initially suggested eustachian valve endocarditis, whereas cardiac magnetic resonance imaging indicated an intracardiac thrombus.
Percutaneous aspiration failed to mobilize the mass, providing mechanical evidence of tissue adherence and low embolic risk that supported deferring immediate high-risk surgery and stopping poorly tolerated anticoagulation.
Elective surgical resection performed 2 months later confirmed a definitive diagnosis of benign cardiac fibroma.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

1 kidney transplant recipient aged 51 years with neutropenic sepsis and an indeterminate right atrial mass, followed for 2 months to elective resection.

I

Intervention

Percutaneous aspiration performed for therapeutic debulking, followed by discontinuation of anticoagulation and elective surgical resection 2 months later

O

Outcome

Definitive diagnosis and clinical resolution via elective surgical resection at 2 months

Limitations

Evidence guiding management of indeterminate right atrial masses is limited.
Evidence guiding management of indeterminate RA masses is limited

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Implication

Right atrial fibromas can mimic thrombus or endocarditis in septic, immunocompromised patients, and incidental resistance during percutaneous aspiration may suggest mass stability and lower embolic risk.

Abstract

BACKGROUND: Management of an undifferentiated right atrial (RA) mass in a septic, immunocompromised patient is challenging when imaging and microbiologic data are discordant. CASE SUMMARY: A 51-year-old kidney transplant recipient presented with neutropenic sepsis and a newly identified RA mass. Transesophageal echocardiography suggested eustachian valve endocarditis, whereas cardiac magnetic resonance imaging favored thrombus. Percutaneous aspiration, performed for therapeutic debulking, incidentally failed to mobilize the mass, suggesting firm adherence and low embolic potential. This informed discontinuation of poorly tolerated anticoagulation and deferral of high-risk surgery. Elective resection 2 months later revealed a cardiac fibroma. DISCUSSION: Evidence guiding management of indeterminate RA masses is limited. Resistance to aspiration may provide functional information about embolic risk. TAKE-HOME MESSAGES: RA fibromas can mimic thrombus or endocarditis, particularly in septic, immunocompromised patients. In select patients already undergoing percutaneous aspiration, incidental procedural resistance may indicate stability and lower embolic risk.

Discussion

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Cite This Study

Prescott et al. (2026) conducted a case report in Right atrial cardiac fibroma with neutropenic sepsis (n=1). Percutaneous aspiration followed by elective surgical resection was evaluated on Definitive histopathologic diagnosis and surgical resection of right atrial mass. Percutaneous aspiration failed to mobilize a right atrial mass in a 51-year-old septic patient, guiding safe deferral of surgery for 2 months until resection confirmed a cardiac fibroma.

synapsesocial.com/papers/6aea7003fa35a3ee5594e43a https://doi.org/10.1016/j.jaccas.2026.109868

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Right Atrial Cardiac Fibroma Mimicking Eustachian Valve Endocarditis in Neutropenic Sepsis

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Right Atrial Cardiac Fibroma Mimicking Eustachian Valve Endocarditis in Neutropenic Sepsis

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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