Calcified right atrial mass: Report of a case and discussion of the differential diagnosis

Abstract

This is the report of a case of a grossly calcified right atrial mass in a woman of 40 who also suffered from systemic hypertension, pyelonephritis, and hepatic cirrhosis. The differential diagnosis, surgical treatment, and necropsy findings are described along with a review of the literature.Myxoma is the commonest intracardiac tumour and it is well known to present in bizarre ways, particularly when on the right side of the heart. The frequency of serious co-existent disease is striking and adds to the difficulty of diagnosis. Calcification of the tumour is uncommon, though probably more frequent in right than in left heart tumours; massive calcification is rare. Diagnosis can be followed by surgery with very satisfactory results.The purpose of this paper is to present the case of an enormous, grossly calcified mass in the right atrium which extended down into the inferior vena cava and was associated with large calcified deposits in the main pulmonary artery and in the lungs. Although no recognizable myxoma tissue remained there is strong evidence that this was, in fact, a 'burnt-out' myxoma. The patient also had chronic pyelonephritis and hepatic cirrhosis.The difficulty of diagnosis is discussed and the literature on calcified atrial myxomata is reviewed. CASE HISTORYMrs. E. L. was aged 40 years when first seen in 1968.In 1951 she had suffered from severe pre-eclamptic toxaemia leading to an abortion at five months. Her blood pressure was 190/120 mmHg and on that occasion pus cells, red blood cells, and granular casts were found in the urine. She was subsequently admitted for inevitable abortions in May and again in August 1955. These were at approximately three and two months' gestation respectively.In June 1968 she was referred for treatment of menorrhagia of six months' duration. She was found to have a blood pressure of 220/160 mmHg and heavy albuminuria. The uterus was bulky and before a dilatation and curettage she was referred for a medical opinion to Dr. K. D. Allanby who made the following observations. She was breathless on climbing stairs. She slept on two pillows and there had been gross ankle oedema for six months. A rash and periorbital oedema had appeared about one week previously and were attributed to strawberries. The venous pressure was above the angle of the jaw, oedema of the legs was well marked, and there was hepatomegaly. A coarse rub, probably of pericardial origin, was heard.A diagnosis of cellulitis of the legs was made, and she was admitted to Peterborough Memorial Hospital immediately. A haemolytic streptococcus was isolated from the throat and she was therefore treated with penicillin. She was also treated with chlorothiazide and methyldopa, with some improvement. However, at the end of one month she was still in congestive cardiac failure and grossly overweight. The treatment of her heart failure was intensified but the result was disappointing. The 'pericardial rub' varied in intensity but never disappeared. On occasions she complained of a feeling of tightness in the chest. ...