Atrial pseudothrombus, a new radiological sign of right atrial roof bulging, caused by pericardial effusion, observed on chest CT

José Vitor Rassi Garcia, Daphine Centola Grassi, Claudia Cosentino Gallafrio, Henrique Manoel Lederman
2019 International Journal of Radiology & Radiation Therapy  
A 22-year-old female patient was admitted to the emergency room of an Oncologic center, with an acute onset of dry cough, hyaline runny nose, and sudden, severe, ventilatory-dependent chest pain, located in the parasternal region with shoulder irradiation, followed by dyspnea. On physical examination, associated findings are perioral and on the distal fingers' phalanges cyanosis. There was no history of fever, paresthesias, syncope, or other symptoms. Six years ago, in 2013, she had been
more » ... ed with 10th right costal arch Askin's tumor with pulmonary metastasis. Initially, she started receiving 1st line chemotherapy according to the Metastatic Ewing Sarcoma Protocol 2010, and then surgical approach for metastatic resection four right costal arches. So far, she has had three relapses, the first in 2016 for the left femur and lungs, in 2017 for the skullcap and 2018 for the right femur and right tibia. Since then, she has been receiving treatment according to an alternative chemotherapy protocol consisting by Topotecan 0.75mg/m² D1 to D5/CTX 250mg/m² D1 to D5 every 21 days and radiotherapy. A year ago, she developed a chronic thrombosis of the left brachiocephalic vein. Abstract Cardiac masses are rare findings, but they may have several etiologies, and classically can be divided as neoplastic or not-neoplastic. 1 Due to the diversity of causes, the patient's clinical data such as age, symptoms, and previous pathological history are essential factors in guiding the diagnosis. The gold standard exam in the investigation of cardiac masses is currently the magnetic resonance exam, which presents high accuracy to differentiate thrombus tumors. 2 Usually the echocardiography plays an important role being the first imaging study in evaluating the heart. 2 However, with the increased use of imaging as a diagnostic method, the cardiac mass may be initially visualized on the chest CT scan. A satisfactory heart evaluation by chest CT is limited if it is non-triggered, mainly because of movement artifacts. However, if there any abnormalities are seen, hypotheses may be made based on patient's clinical story. In the case of atrial cardiac thrombi, multidetector computed tomography showed high sensitivity and specificity for diagnosis. 3,4
doi:10.15406/ijrrt.2019.06.00247 fatcat:gubt7lmxnvgb3jyycjekplocrq