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Cardiovascular Images
September 13, 2021

A Woman With a Right Atrial Mass

Author Affiliations
  • 1Division of Cardiovascular Medicine, Department of Medicine, University of Maryland, Baltimore
JAMA Cardiol. 2021;6(9):e212609. doi:10.1001/jamacardio.2021.2609

What is the abnormality noted on coronary angiography in a patient presenting with chest pain? An adult woman with systemic lupus erythematosus, hypertension, and end-stage kidney disease presented with bacteremia and chest pain. Transthoracic echocardiogram showed a right atrial mass. Coronary computed tomography angiography revealed a right coronary artery (RCA) aneurysm at the acute margin of the right ventricle.1 Fluorodeoxyglucose positron emission tomography did not find an infection site in the RCA region. Following treatment of bacteremia, the patient underwent catheterization of the left side of the heart that showed a very large-caliber RCA with a large (5-cm) spherical aneurysm in the distal vessel with TIMI I flow beyond (Figure, A). Endovascular coil embolization of the aneurysm was performed using 2 framing and 2 filling coils, and then 2 overlapping Graftmaster (Abbott Vascular Inc) covered stents (4.8 × 16 mm) were deployed in the RCA resulting in significant improvement of distal flow (Figure, B).2 The patient remained stable and asymptomatic and was discharged home.

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