Table 1 Suspected preoperative diagnosis of this patient and the basis for the final exclusion of these diagnoses
Suspected diagnoses | Exclusion reasons |
|---|---|
Atrial myxoma | Atrial myxomas are mostly located in the left atrium, and most have a pedicle attached to the atrial septum or left atrial wall. They have good activity and move with the heart cycle [11]. But the patient's echocardiography showed that the mass was located in the right atrium, with a fixed position. Combined with the ultrasound findings and the location of the mass, it was not like a typical atrial myxoma |
Primary cardiac angiosarcoma | Primary cardiac angiosarcoma is a rare malignant tumor that originates in the heart, with the majority of cases arising from the right atrium [12]. Typically presenting as a large mass, it has a tendency to invade adjacent tissues and can easily metastasize to the lungs, liver, and brain in the early stage [13]. Given that the mass in this patient was localized to the right atrium and there was no indication of distant metastasis, insufficient diagnostic evidence existed to support a diagnosis of angiosarcoma |
Atrial metastatic tumors | Based on our clinical experience, the majority of tumors that metastasize to the heart are located in the right atrium, with poor activity and irregular morphology. In this patient, normal levels of tumor markers were observed in blood tests, and no signs of tumors were found in abdominal ultrasonography or head CT scans, indicating no evidence of malignant tumor metastasis |
IgG4-related disease | The patient's CCT showed multiple nodules surrounding each coronary artery and on the left side of the inferior vena cava. Additionally, the serum IgG4 level was mildly elevated. Therefore, we considered IgG4 related disease before surgery and ultimately ruled out this disease through pathological examination |