A 52‐year‐old woman, with no previous past medical history of note, presented with a six‐month history of palpitations and raised jugular venous pressure (JVP). A chest radiograph revealed a large mass adjacent to the right atrium (panel A) which was subsequently confirmed on transthoracic echocardiography. A computed tomographic (CT) scan demonstrated a 15 cm heterogeneous mass of indeterminate origin and extent. Further imaging using magnetic resonance revealed the mass to be arising from the atria (most likely the right atrium) (panel B) and the appearances were consistent with those of a giant myxoma. Furthermore, while there was no evidence of local invasion, compression of the left upper pulmonary vein was evident. Operative exploration was carried out through a median sternotomy. The mass was intrapericardial, lying in the right posterolateral pericardial space, compressing and deforming the right and left atrium. Intraoperative transoesophageal echocardiography confirmed the constrictive effect of this extra‐cardiac mass upon the right and left atria. A preliminary biopsy revealed a benign fibromatous tumour. This was excised one week later through a right thoracotomy without the need for cardiopulmonary bypass (panel C). Upon removal of the mass, haemodymanic parameters returned to normal. The patient made an uneventful postoperative recovery and was discharged home on the sixth postoperative day. Histological examination of the mass confirmed a benign fibroma that was completely excised. Staging using clinical and radiological means was invaluable in ensuring successful resection of this rare tumour.
(A) Chest radiograph demonstrating a large mass silhouetting with right heart border. (B) Magnetic resonance image (MRI) revealing a mass arising from the atria. (C) Visualisation of fibroma following right thoracotomy and incised surface of fibroma. (D) Postoperative MRI following the removal of extrinsic compression upon the left and right atria.