Makihata S, Mihata S, Nakagawa Y, Konishiike A, Tanimoto M, Yamamoto T, Kawai Y, Iwasaki T, Miyamoto T
J Cardiogr. 1983 Sep;13(3):633-48.
Five cases of miscellaneous right atrial mass were described to illustrate the very valuable diagnostic contribution of two-dimensional echocardiography (2DE). Two patients had a large myxoma in the right atrium, and other two had an extension of hepatoma into the right atrium through the inferior vena cava. The fifth patient with a past history of myocardial infarction had a floating right atrial thrombus. The myxoma in the right atrium appeared as a mottled, ovoid, and sharply demarcated mobile mass attached to the interatrial septum. The diagnosis of these two patients was confirmed at operation. The right atrial myxoma in the first case weighed 310 g and filled almost the entire right atrium and right ventricle. To our knowledge, this was the largest myxoma among previously reported cases. The hepatoma extended into the right atrium resembled myxoma, but was obscurely demarcated. The 2DE was useful to localize a large immobile mass extending into the right atrium. All these right atrial tumors were adequately demonstrated in the right lateral decubitus position with the transducer over the right parasternal position. In the fifth case, bedside real-time 2DE was performed after the attack of pulmonary thromboembolism, and an irregular echogenic mass was seen to float freely, suggesting a thrombus. Following the immediate anticoagulant therapy with heparin, the thrombus echo was no longer visible by 2DE. It was concluded that 2DE should be extensively applied to diagnose right atrial tumors or thrombi.
描述了5例右心房肿物以说明二维超声心动图（2DE）非常有价值的诊断作用。2例患者右心房有巨大黏液瘤，另外2例患者肝癌经下腔静脉延伸至右心房。第5例有心肌梗死病史的患者有漂浮的右心房血栓。右心房黏液瘤表现为附着于房间隔的斑驳、卵圆形、边界清晰的活动肿物。这2例患者的诊断经手术证实。第1例的右心房黏液瘤重310 g，几乎充满整个右心房和右心室。据我们所知，这是既往报道病例中最大的黏液瘤。延伸至右心房的肝癌类似黏液瘤，但边界不清。2DE有助于定位延伸至右心房的巨大固定肿物。所有这些右心房肿瘤在右侧卧位、探头置于右胸骨旁位置时均能得到充分显示。在第5例中，肺血栓栓塞发作后进行了床旁实时2DE检查，可见一不规则回声团块自由漂浮，提示血栓形成。立即给予肝素抗凝治疗后，2DE不再可见血栓回声。结论是2DE应广泛应用于右心房肿瘤或血栓的诊断。
