Fioretti AM, Leopizzi T, La Forgia D, Scicchitano P, Oreste D, Fanizzi A, Massafra R, Oliva S. Incidental right atrial mass in a patient with secondary pancreatic cancer: A case report and review of literature. World J Clin Cases 2023; 11(5): 1206-1216 [PMID: 36874413 DOI: 10.12998/wjcc.v11.i5.1206]
Corresponding Author of This Article
Agnese Maria Fioretti, MD, Doctor, Cardio-Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, Bari 70124, Italy. a.fioretti@oncologico.bari.it
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 16, 2023; 11(5): 1206-1216 Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1206
Incidental right atrial mass in a patient with secondary pancreatic cancer: A case report and review of literature
Agnese Maria Fioretti, Tiziana Leopizzi, Daniele La Forgia, Pietro Scicchitano, Donato Oreste, Annarita Fanizzi, Raffaella Massafra, Stefano Oliva
Agnese Maria Fioretti, Stefano Oliva, Cardio-Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
Tiziana Leopizzi, Cardiology and Intensive Care Unit, Ospedale SS. Annunziata, Taranto 74121, Italy
Daniele La Forgia, Donato Oreste, Department of Radiology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
Pietro Scicchitano, Cardiology and Intensive Care Unit, Ospedale “Fabio Perinei”, Altamura (Bari) 70022, Italy
Annarita Fanizzi, Raffaella Massafra, Department of Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
Author contributions: Fioretti AM, Leopizzi T and La Forgia D conceived and wrote the original draft of the manuscript; Scicchitano P, Oreste D and Fanizzi A supervised the manuscript; Massafra R and Oliva S reviewed and edited the manuscript; All authors contributed to the manuscript and approved the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Agnese Maria Fioretti, MD, Doctor, Cardio-Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, Bari 70124, Italy. a.fioretti@oncologico.bari.it
Received: November 16, 2022 Peer-review started: November 16, 2022 First decision: November 30, 2022 Revised: November 30, 2022 Accepted: January 10, 2023 Article in press: January 10, 2023 Published online: February 16, 2023 Processing time: 89 Days and 13.1 Hours
Abstract
BACKGROUND
The incidental detection of a right atrial mass during routine cardioncological workup is a rare condition. The correct differential diagnosis between cancer and thrombi is challenging. A biopsy may not be feasible while diagnostic techniques and tools may not be available.
CASE SUMMARY
We report the case of a 59-year-old female patient with a history of breast cancer and current secondary metastatic pancreatic cancer. She developed deep vein thrombosis and pulmonary embolism and was admitted to the Outpatient Clinic of our Cardio-Oncology Unit for follow-up. Transthoracic echocardiogram incidentally found a right atrial mass. Clinical management was difficult due to the abrupt worsening of the patient’s clinical condition and the progressive severe thrombocytopenia. We suspected a thrombus, according to its echocardiographic appearance, the patient’s cancer history and recent venous thromboembolism. The patient was unable to adhere to low molecular weight heparin treatment. Due to worsening prognosis, palliative care was recommended. We also highlighted the distinguishing features between thrombi and tumors. We proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.
CONCLUSION
This case report highlights the importance of cardioncological surveillance during anticancer treatments to detect cardiac masses.
Core Tip: Cardiac masses are rare occurrences. In this case report, the diagnosis of a right atrial mass during cardioncological follow-up of a patient with secondary metastatic pancreatic cancer and a recent diagnosis of cancer-associated thrombosis was challenging. Severe thrombocytopenia and the rapid worsening of the patient’s condition hindered a complete clinical workup. However, echocardiographic differentiation between thrombi and tumors lead to the diagnosis of a new venous thromboembolism event. We also proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.
