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Aldo L Schenone, Carmela Tan, Douglas Johnston, Maran Thamilarasan, Wael Jaber, Cardiac varix: a rare tumour of the interatrial septum, European Heart Journal - Cardiovascular Imaging, Volume 19, Issue 4, April 2018, Page 470, https://doi.org/10.1093/ehjci/jex330
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A 72-year-old man was evaluated for dyspnoea on exertion, intermittent palpitation, lightheadedness, and head-fullness sensation. His lightheadedness and head-fullness were positional. A cardiac monitor revealed runs of atrial tachycardia. A transthoracic echocardiogram showed a preserved left ventricular ejection fraction with a moderate-severe mitral regurgitation and a mobile circular echodensity in the right atrium. A transoesophageal echocardiogram was performed to further characterize both the mitral regurgitation and the atrial mass. The mitral valve had myxedematous degeneration with severe regurgitation due to bileaflet prolapse. A large (3.2 × 3.7 cm) and highly mobile right atrial cystic mass was identified with swirling echodensity material within (Panel A). It attached to the inter-atrial septum via a stalk (Panel B). The patient underwent open mitral valve repair and right atrial mass resection. The excised mass was a thin-walled cyst measuring 4.5 × 3.0 × 2.0 cm (Panel C). The cyst contained blood with a small amount of thrombus (Haematoxylin–eosin, Panel D), and a smooth calcified thrombus or phlebolith. The cyst wall is composed of dense collagen (yellow) with elastic fibres (black), and smooth muscle cells, lined by endothelium (Movat pentachrome, Panel E). At the base of the lesion, there are a few dilated channels without an obvious connection to the cyst cavity. Based on location, macroscopic and microscopic characteristic, the cystic mass was consistent with a cardiac varix. This is an exceedingly rare tumour of the right atrium described as blood-filled cysts probably representing dilated, thrombosed veins.
