Clinical case report based study
Unusual presentation of a culture-positive right atrial mass

https://doi.org/10.1016/j.jcdr.2013.02.009Get rights and content

Abstract

We report a patient with a mass in the right atrium which led to pulmonary embolism. Postoperatively the mass was identified as a tuberculoma and it was culture-positive for Mycobacterium tuberculosis. Patient responded to modified antitubercular treatment and discharged from hospital in satisfactory condition.

Introduction

Myocardial tuberculosis (TB) is uncommon, with only a few reported cases in the world literature. We present a unique case of a right atrial mass with pedunculated cystic extension floating in the atrial cavity which later on embolized into the pulmonary circulation. Patient underwent pericardiectomy and excision of the tumor mass. Histopathology indicated chronic granulomatous lesion and culture was positive for Mycobacterium tuberculosis. Patient was successfully treated for tuberculosis.

Section snippets

Case report

A 19-year-old female presented with a history of fever, weakness and shortness of breath for one week. She had a history of weight loss of 1–2 kg over a period of two months. Echocardiography revealed a large solid mass (3 × 2 cm) attached to the lateral wall of the right atrium near the superior vena cava right atrial junction. An additional pedunculated cystic mass was floating in the right atrium attached to the above-mentioned mass [Fig. 1]. She did not have a past history of any surgical

Discussion

Extrapulmonary tuberculosis accounts for 15–20% of all mycobacterial infections.1 The commonest sites are the lymph nodes, abdomen and central nervous system. Tuberculosis is generally thought to spare the heart, thyroid, pancreas and skeletal muscle.2

Tuberculosis involving the heart is rare accounting for only 0.5% of extrapulmonary tuberculosis.3 Laennec was the first to describe cardiac tuberculosis in 1826, assigning the heart as the 13th organ affected.4 Cardiac tuberculoma is rare and

Conflict of interest

All authors have none to declare.

Acknowledgments

We would like to thank the Dept. of Histopathology, Medanta – The Medicity for providing the Hematoxylin and eosin stained slides of the right atrial mass.

References (8)

  • A.M. Alkhulaifi et al.

    Right atrial tuberculoma: computed tomography and magnetic resonance imaging

    J Thorac Cardiovasc Surg

    (2007)
  • H.A. Ngow et al.

    Right atrial tuberculoma: a diagnosis too late

    Cardiol J

    (2011)
  • X. Njovane

    Intramyocardial tuberculosis a rare underdiagnosed entity

    S Afr Med J

    (2009)
  • E. Rodriquez et al.

    CT and MR findings in a calcified myocardial tuberculoma of the left ventricle

    J Comput Assist Tomogr

    (2001)
There are more references available in the full text version of this article.

Cited by (2)

  • Endocardial tuberculosis

    2014, Annals of Thoracic Surgery
    Citation Excerpt :

    Endocardial involvement by TB is extremely rare, with only a few live reported cases to date [3–5]. There are few reports of tubercular valvular endocarditis and of the 3 live patients reported, 2 were diagnosed on typical histopathologic appearances and 1 was diagnosed by positive culture of the excised valve [6–8]. However, actual visualization of AFB in an intracardiac lesion has not been reported so far and tubercular vegetation must be considered in the differential diagnosis of left atrial masses.

View full text