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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 239-240

Giant idiopathic right atrial aneurysm in an adult: Sonological appearance of a rare feature


1 Department of Radiology, St. John's Hospital, Kattappana, Kerala, India
2 Department of Medicine, INHS Kalyani, Visakhapatnam, Andhra Pradesh, India

Date of Submission21-May-2020
Date of Acceptance24-Jul-2020
Date of Web Publication18-Dec-2020

Correspondence Address:
Dr. Reddy Ravikanth
Department of Radiology, St. John's Hospital, Kattappana - 685 515, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_42_20

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How to cite this article:
Ravikanth R, Majumdar P. Giant idiopathic right atrial aneurysm in an adult: Sonological appearance of a rare feature. BLDE Univ J Health Sci 2020;5:239-40

How to cite this URL:
Ravikanth R, Majumdar P. Giant idiopathic right atrial aneurysm in an adult: Sonological appearance of a rare feature. BLDE Univ J Health Sci [serial online] 2020 [cited 2021 Apr 14];5:239-40. Available from: https://www.bldeujournalhs.in/text.asp?2020/5/2/239/303968



Sir,

A 24-year-old female presented with complaints of right-sided lower chest pain and discomfort. She did not provide a history of dyspnea on exertion or any significant history of comorbidities. The patient was referred for ultrasonography evaluation of the abdomen which revealed a giant aneurysmal dilatation of the right atrium (RA). There was associated severe dilatation of the annulus of the tricuspid valve [Figure 1]. Differential diagnosis considered was Takotsubo cardiomyopathy considering the age of the patient. Chest radiography revealed severe cardiomegaly with a cardiothoracic ratio of 87%. The patient was referred for echocardiography and contrast-enhanced computed tomography examination of the thorax for further evaluation which confirmed giant aneurysmal dilatation of the RA. The confirmation of diagnosis is based on ruling out other causes of RA enlargement such as Ebstein's anomaly, massive pulmonary emboli, severe pulmonary hypertension, severe mitral valve disease, and tricuspid stenosis. She was advised to undergo subsequent reduction atrioplasty of the RA and tricuspid valve ring annuloplasty. Giant idiopathic aneurysmal dilatation of the RA is a very rare anomaly and must be differentiated from massive enlargement of RA which is frequently encountered with rheumatic valvular heart disease.[1] Giant right atrial aneurysm is also known as idiopathic dilatation and idiopathic enlargement of the RA (IDRA) and as right atrial congenital aneurysm. Common conditions leading to enlarged RA in adults are severe mitral valvular disease with pulmonary hypertension, chronic obstructive pulmonary disease, pulmonary emboli, and tricuspid valvular disease.[2] The development of symptoms in idiopathic aneurysmal dilatation of the RA is dependent on ventricular compression, thromboembolism, atrial dysrhythmias, and tricuspid regurgitation.[3] There is no consensus as to whether IDRA is a congenital or an acquired defect. Congenital absence of atrial myocardium and acquired degenerative conditions of the atrial myocardium were possible explanations leading to a giant idiopathic right atrial aneurysm.[4] Echocardiography is the mainstay of diagnosing IDRA.[5] Surgical reduction atrioplasty is recommended even for asymptomatic patients with giant aneurysmal dilatation of the RA to prevent the risk of future thromboembolic complications and dysrhythmias.[6] In conclusion, familiarity with the imaging appearance of this rare feature helps to arrive at a diagnosis and initiate timely intervention which can prevent sudden death which is a known complication of the condition.
Figure 1: Transverse ultrasonography image demonstrating a giant aneurysmal dilatation of right atrium opening into the right ventricle. Note the severe dilatation of the annulus of the tricuspid valve (annotation)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Long MA. Giant right atrium: An extreme case of idiopathic dilation of the right atrium. Ann Thorac Surg 2014;98:1815-8.  Back to cited text no. 1
    
2.
Ariyarajah V, Soni A, Morris A. Giant right atrium in an adult. Echocardiography 2008;25:1121-3.  Back to cited text no. 2
    
3.
Binder TM, Rosenhek R, Frank H, Gwechenberger M, Maurer G, Baumgartner H. Congenital malformations of the right atrium and the coronary sinus: An analysis based on 103 cases reported in the literature and two additional cases. Chest 2000;117:1740-8.  Back to cited text no. 3
    
4.
Blondheim DS, Klein R, Plich M, Marmor AT. Familial idiopathic dilatation of the right atrium with complete atrio-ventricular block: A new syndrome? Cardiology 2000;94:224-6.  Back to cited text no. 4
    
5.
Kurz DJ, Oechslin EN, Kobza R, Jenni R. Idiopathic enlargement of the right atrium: 23 year follow up of a familial cluster and their unaffected relatives. Heart 2004;90:1310-4.  Back to cited text no. 5
    
6.
Hager S, Mahrholdt H, Goldfarb LG, Goebel HH, Sechtem U. Images in cardiovascular medicine. Giant right atrium in the setting of desmin-related restrictive cardiomyopathy. Circulation 2006;113:e53-5.  Back to cited text no. 6
    


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