Large atrial mass in a patient with Crohns disease: organised thrombus mimicking a myxoma

Description

A right atrial mass was incidentally discovered on a CT in a 30-year-old female patient with an 11-year history of Crohn's disease. Medical treatment included infliximab and azathioprine. She denied chest pain, palpitations, orthopnoea or dyspnoea. Transoesophageal echocardiography showed a large, 2.9x2.2 cm, non-obstructive, mobile mass attached by a broad stalk to the lateral wall of the right atrium (online  and figure 1). An atrial myxoma was suspected, and the tumour was completely extirpated. No other mass was found inside the atrium, and the cava veins were patent and free. Surprisingly, histological examination revealed an organised thrombus with no evidence of myxoma. The patient was discharged with long-term warfarin and had an uneventful recovery and no further episodes of thrombosis (2-year follow-up).

Figure 1

Transoesophageal echocardiogram showing a 2.2x2.9 cm mass in the right atrium.

The most frequent causes of thrombus formation...

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