Use of cardiovascular magnetic resonance in the evaluation of a giant right atrial appendage aneurysm: a case report and review of the literature

BMC Res Notes. 2017 Dec 4;10(1):681. doi: 10.1186/s13104-017-3046-2.

Abstract

Background: Right atrial appendage aneurysms are rare entities that may have significant clinical consequences. When co-existing with atrial fibrillation, patients are at risk of developing pulmonary or paradoxical systemic emboli.

Case presentation: An elderly patient presented to medical attention with symptoms of acute diverticulitis. On abdominal computed tomography, a massively enlarged right atrial appendage aneurysm was discovered incidentally. The aneurysm caused marked compression of the right ventricle and contained an area of hypoenhancement concerning for an intraluminal thrombus. Gadolinium-enhanced cardiovascular magnetic resonance was performed and first-pass perfusion images demonstrated that the area of hypoenhancement was in fact poorly mixing blood. The patient was therefore managed medically.

Conclusion: Right atrial appendage aneurysms are infrequently encountered cardiac abnormalities. In the literature, surgery has been offered to patients who are young, symptomatic, or have evidence of thrombotic disease, although whether this practice pattern is associated with superior clinical outcomes is unclear. In the present case, gadolinium-enhanced cardiovascular magnetic resonance imaging was used to exclude the presence of intraluminal thrombus in an elderly patient, which helped orient the patient's treating team towards medical-rather than surgical-therapy.

Keywords: Cardiovascular magnetic resonance (CMR); Congenital heart anomaly; Right atrial appendage aneurysm; Thrombus.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / complications
  • Abdominal Pain / diagnostic imaging*
  • Abdominal Pain / pathology
  • Acute Disease
  • Aged
  • Atrial Appendage / diagnostic imaging*
  • Atrial Appendage / pathology
  • Diverticulitis / complications
  • Diverticulitis / diagnostic imaging*
  • Diverticulitis / pathology
  • Heart Aneurysm / complications
  • Heart Aneurysm / diagnostic imaging*
  • Heart Aneurysm / pathology
  • Humans
  • Incidental Findings
  • Magnetic Resonance Imaging
  • Thrombosis / complications
  • Thrombosis / diagnostic imaging*
  • Thrombosis / pathology
  • Tomography, X-Ray Computed