3. History
• A 37 year old female patient, presented with
• H/o breathlessness on exertion -2 months duration. NYHA-II
• H/O giddiness on and off
• h/o constitutional symptoms -2 months
• Known case of bronchial asthma (seasonal )
• P2L2, both LSCS
4. General Examination
GC- fair, afebrile, tachypneic
HR-106/min, BP-100/70mmhg, SPO2-99%RA
CVS –S1,S2 heard
EDM over the Tricuspid area.
RS- BAE+, No added sounds
P/A –soft, BS+
CNS – NFND.
5.
6. ECG
• Normal standardization
• 25mm/sec
• Sinus tachycardia
• Rate 120/min, regular
• Normal axis
• P wave – normal
• No ST-T changes
7. Echocardiography :
• No RWMA
• LVID: 49/22/63%, normal LVSF
• RA mass size 31x20mm attached to interatrial
septum. Mass protruding into RV during diastole
causing tricuspid inflow obstruction
• TVG -10(P)/4(M)
• No MS/MR/AS/AR
• Tricuspid valve –appears normal, free from mass
• No PE
• TAPSE-21mm
8.
9. INVESTIGATIONS:
CBC – within normal limit
D-Dimer- 1.41
CECT chest – F/S/O RA ?myxoma/? thrombus, with possibility of pulmonary
thromboembolism
CT- pulmonary angiogram
Impression:
• Right atrial myxoma with possibility of chronic thromboembolism in
bilateral pulmonary arteries
12. OPERATIVE FINDINGS
• Patient underwent RA mass excision with Right pulmonary endarterectomy
Intraoperative findings
• RA myxoma found attached to the IAS of size 4x3 cm protruding into RV
attached to the portion of IVC
• Tricuspid valve is free of myxomatous lesion
• R pulmonary thrombus seen measuring 6x1 cm after bifurcation of the
main pulmonary artery
13.
14. • Post operative period
• Uneventful
• Pt generl condition improved and discharged with oral
anticoagulants.
Histopathology report:
• REPORT awaited
15. POST OP ECHO :
RA mass of size 1.4x1cm,
hypoechoic mass present in
the RA
No RWMA
EF – 60%
NO MS/MR/AS/AR
NO TR/PHT
NO PE
