A surprising atrial mass

Clinical History

A 72-year-old man was admitted to hospital following an episode of severe chest pain. The patient had no prior medical history and was not taking any medication. Physical examination and blood and biochemical profiles, including troponin T levels, were all normal. The ECG showed left bundle branch block.

Imaging Findings

Ecocardiography showed a large mass that appears to fill the cavity of the left atrium. It was not possible to distinguish between an intra-atrial and an extra-atrial mass with extrinsic compression of the left atrium. Magnetic resonance imaging was performed to detect the localisation of the mass and characterise it. Haste T2 sequences on axial and sagittal planes, kinetic TrueFISP sequences on left long axis (Fig.1) and on short axis (Fig.2) showed a large hiatal hernia, and confirmed the posterior mediastinal mass to be the stomach.

Discussion

Two-dimensional echocardiography is a valuable diagnostic tool for the detection of various intra-atrial masses, such as thrombus and tumours. However, various adjacent extracardiac structures may closely mimic intracardiac masses on a two-dimensional echocardiogram [1, 2]. The echocardiographic appearances of various anomalies of these adjoining structures have been described and these include mediastinal spread of bronchogenic carcinoma, various other mediastinal tumours, descending thoracic aortic aneurysms and even oesophageal carcinoma. Computed Tomography with oral administration of contrast medium and Cardiac Magnetic Resonance Imaging may help distinguish extra-cardiac and intra-cardiac masses and, as in this case, diagnose hiatal hernia.

Differential Diagnosis List

Final Diagnosis

A large hiatal hernia mimicking an atrial mass.

URL:	https://www.eurorad.org/case/9251
DOI:	10.1594/EURORAD/CASE.9251
ISSN:	1563-4086