An unusual case of left atrial “Mass” by Ashwin Singh Chouhan in Journal of Clinical Case Reports Medical Images and Health Sciences.

An unusual case of left atrial “Mass” by Ashwin Singh Chouhan in Journal of Clinical Case Reports Medical Images and Health Sciences.

Abstract

We present a case of a 19-year-old patient who was admitted to our hospital due to persistent fever and weight loss. Cardiovascular imaging revealed signs of constrictive pericarditis and also the presence of a left atrial mass. Interestingly, empiric anti-inflammatory treatment not only reversed the pericardial constriction, but also reduced the size of this mass, which likely represented inflammatory content in the oblique pericardial sinus. The sinuses of the pericardium should be included in the differential diagnosis of cardiac masses, especially in the simultaneous presence of pericardial diseases.

Case presentation

A 19-year-old patient of Pakistani ethnicity was transferred to the Internal Medicine department of our hospital from a peripheral hospital due to persistent fever and weight loss. He had been living in Greece for the previous four months and had been receiving treatment for acute pericarditis for the previous three months. The initial findings of the workup were low-grade fever and mildly elevated inflammatory markers, while the serological tests for common causes of persistent fever were negative. The requested transthoracic echocardiogram revealed mildly reduced left ventricular systolic performance, a bouncing motion of the interventricular septum, a thickened pericardium with echodense content, mitral annular velocities with an “annulus reversus” pattern, a dilated inferior vena cava with poor respiratory variation and an echodense mass at the posterolateral wall of the left atrium that followed the motion of the atrial wall and projected into the left atrial chamber (Figure 1A-F). The transoesophageal echocardiogram, performed for the better evaluation of the left atrial mass, showed echo dense structures into the pericardial cavity around the right ventricular wall but failed to visualize the aforementioned mass. (Figure 1H) A thoracic CT scan showed the presence of encysted pericardial effusions with contrast enhancement of the cystic walls.


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