Surgical excision of a persistent right atrial mass after 3 months of unsuccessful rivaroxaban therapy revealed a rare calcified fibrinous thrombus masquerading as a cardiac tumor.
Case Report (n=1)
Persistent right atrial masses despite anticoagulation should prompt surgical evaluation, as calcified thrombi can mimic tumors and resist medical therapy.
Abstract Right atrial (RA) masses are rare & pose diagnostic challenges due to overlapping imaging features of thrombi & tumors. Differentials include thrombus, myxoma, lipoma, angiosarcoma, & metastasis. Calcified RA thrombi are rare with only isolated cases reported. Most resist anticoagulation, mimicking tumors. Case 42 y/o F w/ PMH of PCOS, endometriosis, colon adenocarcinoma in remission, presented w/ worsening SOB. CT revealed PE & 2.9 cm RA mass. TTE/TEE showed 3x2cm echogenic spherical RA mass. EF 50-55%, mild RA dilation, grade II DD. Pt already on rivaroxaban but no change in mass size. Cardiothoracic surgery was consulted & pt underwent surgery with removal of 3.5x2x2cm mass. Pathology showed acellular, calcified fibrinous clot without malignant cells. Decision-Making Initially suspicion that the mass was thrombus, pt was on Rivaroxaban, but after 3 months of anticoagulation, repeat imaging showed size unchanged. Thus, thrombus seemed less likely & we intervened surgically which showed a calcified thrombus. Conclusion Thrombi appear echogenic & mimic tumors on echo. TEE, Cardiac MRI (CMR) & Cardiac CT are key imaging tools. Persistent mass despite anticoagulation needs surgical evaluation. Calcified thrombi are less likely to resolve with medical therapy alone and thus workup for alternate diagnosis must be done. Histopathology is gold standard for diagnosis & DOACs are treated mainstay. Assessment for embolic symptoms is important. Prompt differentiation between thrombus and tumor avoids delays in definitive treatment. No guidelines exist for diagnosis or management to address such cases, thus our case highlights need for further research. This abstract is funded by: None
Misbah et al. (Fri,) conducted a case report in Calcified Right Atrial Thrombus (n=1). Surgical excision was evaluated. Surgical excision of a persistent right atrial mass after 3 months of unsuccessful rivaroxaban therapy revealed a rare calcified fibrinous thrombus masquerading as a cardiac tumor.