RadioGraphics 2011; 31:1053-1058
Leila C. Bender, MD , Lee M. Mitsumori, MD , Kelly A. Lloyd, MD Lloyd E. Stambaugh III, MD
History
A 55-year-old woman with a history of hypertension and multiple cesarean sec-tions presented for her annual physical examination. The patient had undergone menopause 4 years earlier and had a 28-year history of oral contraceptive use. She reported a recent diagnosis of asthma. Routine electrocardiography showed slight changes from the previous year. Stress electrocardiography was subsequently per-formed, and before being aborted due to the patient's shortness of breath, dem-onstrated ST depression in the inferior and anterolateral leads. Echocardiography revealed a mass within the right atrium. At physical examination, the patient had fullness in the right lower quadrant and mild lower extremity edema.
Imaging Findings
Cardiac magnetic resonance (MR) imaging was performed at the community hospital where the patient first presented. Images from this study demonstrated a 5 x 4-cm mobile mass within the right atrium with a stalk extending down into the inferior vena cava (IVC). The mass prolapsed across the tricuspid valve and into the right ventricle during diastole with associated tricuspid regurgitation (Fig l).The right ventricular ejection fraction was slightly low at 37% (lower limit of normal = 40%), but the left ventricular ejection fraction was normal at 69% (lower limit of normal = 50%). Findings of mild right atrial and right ventricular enlargement and diastolic interventricular septal flattening suggested increased right ventricular pressure.