Download Case of an elevated right hemidiaphragm appearing as a mass

European Heart Journal - Cardiovascular Imaging Advance Access published June 22, 2012
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doi:10.1093/ehjci/jes127
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Case of an elevated right hemidiaphragm appearing as a mass adjacent
to the right atrium
Jhansi L. Ganji1, Hari P. Chaliki1*, Mohammad Q. Najib1, Prasad M. Panse2, and Roger L. Click3
1
Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA; 2Department of Radiology, Mayo Clinic, Scottsdale, AZ, USA; and 3Division of Cardiovascular
Diseases, Mayo Clinic, Rochester, MN, USA
* Corresponding author. Email: [email protected]
Conflict of interest: none declared.
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2012. For permissions please email: [email protected]
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An 80-year-old man with prior renal cancer and
non-ischaemic cardiomyopathy sought care at
our institution for the evaluation of obstructive
jaundice. He had reported abdominal pain to his
family members a few weeks previously. Transthoracic echocardiography performed for the
evaluation of cardiomyopathy showed decreased
left ventricular systolic function (ejection fraction,
19%). In addition, there was a large mass compressing the right atrium (Figure 1A). The differential
diagnosis on the basis of this finding was a mass
within the right atrium (benign or malignant
tumours, thrombi, or infection) or mass or compression extrinsic to the right atrium. Intracardiac
right atrial masses due to tumours are often
myxomas, angiosarcomas, lymphomas, or renal
cell carcinomas, whereas intracardiac right atrial
thrombi can be due to indwelling catheters such
as central venous lines or pacemakers or deep
venous thrombosis with extension into the right
atrium. Extrinsic compression of the right atrium
can be due to mediastinal or lung tumours and diaphragmatic hernia. Less common causes of ‘right atrial mass’ include tuberculoma,
fungus ball, ectopic liver, haemangioma, hepatocellular carcinoma, pheochromocytoma, intravenous leiomyomatosis, extranodal RosaiDorfman disease, and an aneurysm or pseudoaneurysm of the right coronary artery or saphenous vein graft. A gastroenterologic
evaluation during the patient’s visit included review of computed tomographic images obtained at an outside institution, which
revealed the elevation of the right hemidiaphragm (Figure 1B and C ) corresponding to the mass seen on transthoracic echocardiography. This is an unusual case of an apparent mass observed during transthoracic echocardiography that turned out to be an elevated
right hemidiaphragm.
Figure 1 (A) Apical four-chamber view on transthoracic echocardiography showing a large mass compressing the right atrium (RA)
(arrows). (B) Computed tomographic axial image showing the elevation of the right hemidiaphragm (arrow). (C) Computed tomography, coronal view, showing elevation of the right hemidiaphragm (arrow). LA, left atrium; LV, left ventricle; RV, right ventricle.