calcified right atrial mass
TRANSCRIPT
c© 2012 Wiley Periodicals, Inc. 1
IMAGES IN CARDIAC SURGERY
Calcified Right Atrial MassSuresh Babu Kale, M.Ch. and Jagannathan Raghavan, M.Ch.
Institute for Cardiac Treatment and Research, Southern Railway Headquarter Hospital,Perambur, Chennai, India
doi: 10.1111/j.1540-8191.2012.01436.x (J Card Surg 2012; ∗∗ :1-2)
A 74-year-old female was referred with a large mo-bile thrombus in the inferior vena cava (IVC), extendingfrom the renal veins into the right atrium and right ven-tricle extending across the tricuspid valve (Fig. 1). Thepatient had presented with hematuria and was found tohave right-sided obstructive uropathy with mid-uretericcalculus and a large left-sided staghorn calculus. Shehad hypothyroidism and diabetes mellitus and a perma-nent pacemaker was implanted 4 years ago through theleft subclavian vein for sick sinus syndrome. Through
Conflict of interest: None.
Address for correspondence: Dr. Suresh B Kale, M.Ch., ConsultantCardiovascular Thoracic Surgeon, Institute for Cardiac Treatment andResearch, Southern Railway Headquarter Hospital, Perambur, Chennai600023, India. Fax: +91-44-26743051; e-mail: [email protected]
Figure 1. Fluoroscopy image of the calcified mass extendingfrom the inferior vena cava to the right ventricle across thetricuspid valve.
Figure 2. Intraoperative photograph showing the calcifiedmass in the right atrium alongside the pacing lead.
Figure 3. Enucleated calcific mass against a measuring scale.
a median sternotomy and under brief deep circulatoryarrest, a hard calcific thrombus entering the tricuspidvalve was enucleated from the IVC (Fig. 2). It wasfree from the IVC, right atrial wall, and the tricuspidapparatus and measured 21 cm (Fig. 3). Though thetricuspid valve apparatus was normal at surgery, we
2 KALE AND RAGHAVANCALCIFIED RIGHT ATRIAL MASS
J CARD SURG2012; ∗∗:1-2
suspect that the pacing lead could have injured theleaflet and acted as a nidus for clot deposition and cal-cification which extended down the IVC. The procedurewas uneventful and the patient made a smooth post-
operative recovery. Histopathology of the enucleatedmass was reported as a calcified thrombus. The patienthas done well on oral anticoagulation and antiplateletdrugs.