Congenital aneurysm of the right atrial appendage in a newborn: a rare anomaly

Markedly dilated right atrium in an infant: what is the diagnosis?

An 18-month-old boy presented with recurrent episodes of irritability and documented fast heart rate suggestive of supraventricular tachycardia. Cardiovascular examination revealed significant cardiomegaly, normal heart sounds and no murmurs. The differential diagnosis of marked right atrial dilatation and management principles of idiopathic dilatation of the right atrium are described.

Surgical Repair of a Giant Right Atrium Aneurysm That was Incidentally Found in a Boy

Giant right atrial aneurysms are rare defects with different clinical presentations ranging from lack of symptoms to heart failure. They are diagnosed based on incidental findings. It is commonly found when echocardiography or chest X-ray is performed. Concurrent congenital heart disease and large atrial size are risk factors that may increase the risks of complications such as thromboembolism, fatal arrhythmias, aneurysm rupture, and sudden death. The best treatment has been controversial, with some patients managed surgically and others conservatively. We present a case of a giant right atrium aneurysm that was incidentally detected during a routine examination. The patient underwent successful surgical resection of the right atrial aneurysm.

Two case reports of right atrial aneurysm

INTRODUCTION

Right atrial aneurysm (RAA) is a rare congenital heart disease (CHD) that usually shows no symptom and is discovered occasionally. This paper introduces the clinical and imaging data obtained in 2 RAA patients and presents a related literature review with the aim of increasing understanding of this disease.

PATIENT FOCUS

One case showed chest distress, while the other showed symptoms on physical examination and positive signs.

DIAGNOSIS

Both of these 2 cases were diagnosed with RAA based on ultrasonography, computed tomography angiography (CTA), and enhanced magnetic resonance imaging (MRI) examinations.

INTERVENTIONS

One patient was orally administered warfarin anticoagulant therapy, while the other was given amiodarone to control arrhythmia as well as warfarin anticoagulant therapy.

RESULTS

The clinical symptoms of both cases were not aggravated.

CONCLUSIONS

RAA is a rare cardiac anomaly that can induce severe complications, and it is mainly diagnosed based on imaging examinations. Conservative treatment and regular imaging monitoring are recommended for asymptomatic patients with no high-risk factors, while surgical treatment should be performed in symptomatic patients with high-risk factors.

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

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.

Electronic supplementary material

The online version of this article (10.1186/s13104-017-3046-2) contains supplementary material, which is available to authorized users.

Congenital aneurysm of the right atrial appendage

Congenital aneurysm of the right atrial appendage is a rare cardiac anomaly with only a few reported cases in the literature. Most of the cases involved adults in their third decade of life. We report a case of congenital aneurysm of the right atrial appendage in a newborn, who initially presented with jaundice and incidentally discovered systolic murmur. The diagnosis was established by enhanced CT scan of the chest and echocardiography that also showed atrial septal defect (ASD) and multiple ventricular septal defects (VSDs). Because of its rare occurrence, diagnosis is difficult and the symptoms may be confused with other causes of right atrial dilation such as Ebstein's anomaly.

[Giant congenital intrapericardial left atrial appendage aneurysm: about a case and review of the literature]

L'anévrysme auriculaire gauche est une anomalie cardiaque très rare. Il peut être d'origine congénitale ou acquise; secondaire à des processus inflammatoires ou dégénératifs. La plupart des cas sont asymptomatiques. La prévalence de ces lésions chez des patients d'âge pédiatrique a été très rarement décrite. Comme il peut provoquer des arythmies potentiellement mortelles ou des thrombus, le traitement chirurgical est nécessaire immédiatement après le diagnostic. Dans cet article, nous présentons le cas d'un garçon de 14 ans qui rapporte une dyspnée rapidement progressive, des palpitations, avec une notion de vertiges répétitifs et lipothymies, chez qui on découvre un anévrysme auriculaire gauche congénital. Le diagnostic a été basé sur les données du Coro scanner. Le patient a été traité avec succès par résection chirurgicale de l'anévrysme.

Right atrial appendage aneurysm: a systematic review

BACKGROUND

Right atrial appendage aneurysm (RAAA) is rare with fewer than 20 cases reported in the literature. We sought to systematically review the published cases of RAAA in terms of demographics, clinical characteristics, treatment, complications, and outcome.

METHODOLOGY

Electronic search for case reports, case series, and related articles published until July 2013 was carried out and clinical data were extracted and analyzed.

RESULTS

Seventeen cases of RAAA were identified with equal sex distribution and commonly presenting in the third decades of life. Dyspnea and palpitation were the most common clinical presentations. Echocardiography was the most common diagnostic modality. The mean size of aneurysm was 8.83 ± 4.84 × 6.05 ± 2.99 cm. Most of the patients were treated medically with close follow-up. The mean follow-up period was 10 months. Atrial tachyarrhythmias and heart failure were the most common complications.

CONCLUSION

Right atrial appendage aneurysm although rare may be associated with significant morbidity. Surgical resection is indicated in symptomatic patients.