Giant Right Atrial Pseudoaneurysm Sivasubramanian Muthukumar, MCh, MRCS, Thangavel Periyasamy, MCh, Rajesh Venkataraman, MCh, Jayavelan Ramkumar, MCh, Dheeraj Reddy, MCh, Aashish Chopra, MD, Swaminathan Rajendiran, MD, and J. S. Satyanarayana Murthy, DNB Department of Cardiothoracic Surgery, Department of Cardiology, Department of Pathology, Sri Ramachandra University, Chennai, India
FEATURE ARTICLES
Fig 1.
Fig 2.
A
33-year-old woman presented with right-sided chest pain, dry cough, and orthopnea. On examination, she was dyspneic with features of superior vena caval compression. Air entry was absent on right side. Chest radiography showed a large opacity in the right hemithorax. Contrast-enhanced computed tomography of the thorax (Fig 1A) revealed large right atrial pseudoaneurysm with mural thrombus associated with bilateral multiple lung nodules. Echocardiographic evaluation confirmed large paracardiac collection communicating Address correspondence to Dr Muthukumar, Department of Cardiothoracic Surgery, F6, Sixth Flr, Sri Ramachandra Medical Centre, Porur, Chennai 600116, India; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
with right atrium. Median sternotomy was performed after institution of femorofemoral cardiopulmonary bypass. Operative findings included large aneurysmal cavity occupying the entire right hemithorax with massive thrombus, ruptured and fenestrated right atrial wall (Fig 1B), and multiple bilateral lung metastatic nodules (Fig 2A). The procedure included aneurysm repair, clot evacuation, reconstruction of right atrium with bovine pericardial patch and biopsy of atrial wall, and a metastatic lung nodule. Histopathologic analysis confirmed a high grade angiosarcoma of atrial wall with lung metastases. With immunohistochemistry, tumor cells were positive for vimentin and CD 34 (Fig 2B). The patient was referred for adjuvant chemotherapy. Ann Thorac Surg 2015;99:2223 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.12.101
FEATURE ARTICLES
Fig 1.
Fig 2.
A
33-year-old woman presented with right-sided chest pain, dry cough, and orthopnea. On examination, she was dyspneic with features of superior vena caval compression. Air entry was absent on right side. Chest radiography showed a large opacity in the right hemithorax. Contrast-enhanced computed tomography of the thorax (Fig 1A) revealed large right atrial pseudoaneurysm with mural thrombus associated with bilateral multiple lung nodules. Echocardiographic evaluation confirmed large paracardiac collection communicating Address correspondence to Dr Muthukumar, Department of Cardiothoracic Surgery, F6, Sixth Flr, Sri Ramachandra Medical Centre, Porur, Chennai 600116, India; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
with right atrium. Median sternotomy was performed after institution of femorofemoral cardiopulmonary bypass. Operative findings included large aneurysmal cavity occupying the entire right hemithorax with massive thrombus, ruptured and fenestrated right atrial wall (Fig 1B), and multiple bilateral lung metastatic nodules (Fig 2A). The procedure included aneurysm repair, clot evacuation, reconstruction of right atrium with bovine pericardial patch and biopsy of atrial wall, and a metastatic lung nodule. Histopathologic analysis confirmed a high grade angiosarcoma of atrial wall with lung metastases. With immunohistochemistry, tumor cells were positive for vimentin and CD 34 (Fig 2B). The patient was referred for adjuvant chemotherapy. Ann Thorac Surg 2015;99:2223 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2014.12.101
