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Clinical Cases: Masses, tumors and source of embolism, European Heart Journal - Cardiovascular Imaging, Volume 17, Issue suppl_2, December 2016, Pages ii3–ii5, https://doi.org/10.1093/ehjci/jew231
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The patient, a woman of 58 y.o., was submitted to the outpatient department due to the rarely occurring feeling of palpitation. Her ECG contained the signs of right atrial enlargement. Holter monitoring revealed few paroxysms of non-sustained supra-ventricular tachycardia. Standard TTE showed a cavity of 77x57 mm with echo negative content situated laterally to the right atrium, separated from it with a membrane. The structure neighbored also the inflow part of the right ventricle. Right atrium looked partially compressed. It was not obvious if this cavity was connected to the heart chambers or not. We thought of the differential diagnosis between pericardial cyst and right atrial or right ventricular diverticulum or aneurism. For that purpose right chamber contrast opacification with saline injection was performed. The contrast agent opacified the cavity together with the right chambers. The connection between the structure and the right atrium was well seen in this regiment. We confirmed the diagnosis of right atrial diverticulum. However, an additional information regarding its actual size was needed. It was also necessary to exclude the presence of thrombus inside the diverticulum. Therefore, cardiac ECG-gated MDCT with intravenous contrast injection was performed in order to answer these questions. The structure of interest was visualized. Its maximal sizes were measured as 91x59x94 mm. It was filled with the contrast agent with no evidence of filling defects. Signs of right chambers compression were described. The diagnosis of giant right atrial diverticulum was confirmed. Right atrial diverticulum is a rare congenital abnormality. Multimodality imaging gives a good opportunity to provide a correct diagnosis for such patients. Right heart contrast opacification remains a useful tool for the non-invasive visualization and differential diagnostics of the right heart congenital abnormalities. Up to the literature data in some cases, this abnormality was associated with sudden cardiac death. It is also known to increase the risk thromboembolic events. In symptomatic cases surgical treatment is recommended, however in this case of oligosymptomatic patient as we did not found any evidence of neither life threatening arrhythmia nor thrombus formation, it was decided to start as a first line conservative treatment with oral anticoagulants.
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