A 70-year-old woman with a 10-year history of a 30-mm pancreatic cyst was referred
to our center to continue follow-up. Of note, before the procedure she reported worsening
dyspnea and fatigue over the last 4 months. However, no significant alterations were
found on either preliminary cardiological or pneumological evaluation. Endoscopic
ultrasound (EUS) confirmed the multilocular cystic lesion in the pancreatic body originating
from the branch ducts, with focally thickened enhanced walls and a dilation of the
main pancreatic duct (6 mm), as per a mixed-type intraductal papillary mucinous neoplasm
(IPMN) with worrisome features. While withdrawing the echoendoscope into the mediastinum,
a mainly hyperechoic 70 × 50-mm inhomogeneous mass was detected in the right atrium
([Video 1]), with an extension towards the superior vena cava access ([Fig. 1]). Owing to the suspicion of a cardiac mass, multimodality cardiac imaging was performed,
confirming an endoluminal right atrial mass ([Fig. 2]), with inhomogeneous contrast enhancement, partially engaging the atrial outlet
of the superior vena cava ([Fig. 3]). Thus, the patient underwent surgical resection of the mass.
Video 1 Accidental diagnosis of a right atrial mass during endoscopic ultrasound in a patient
with intraductal papillary mucinous neoplasm of the pancreas and dyspnea.
Fig. 1 Right atrial mass with extension towards the superior vena cava access.
Fig. 2 Computed tomography scan of the right atrial mass.
Fig. 3 Magnetic resonance imaging of the right atrial mass.
Final diagnosis on the surgical specimen revealed an atrial myxoma. Atrial myxomas
are rare tumors that may cause fatigue, syncope, shortness of breath, orthopnea, or
pulmonary edema [1]. A few cases of left atrial myxoma have already been described that were found incidentally
during EUS [2]
[3]. Interestingly, in this case the right atrium was visible due to the presence of
the mass and its extension towards the superior vena cava. It is known that the more
you look, the more you see, and EUS is a powerful tool for looking at the anatomical
structures and abnormalities around the gastrointestinal tract. In this case, the
dyspnea prompted our curiosity to examine the cardiac morphology before turning on
the light in the endoscopic room.
Endoscopy_UCTN_Code_CCL_1AF_2AC
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