59 year old man with history of anterior mediastinal neuroendocrine tumor with metastatic disease, found to have a right atrial mass on previous imaging, referred for cardiac MRI to better evaluate for etiology. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 44 ml/m2 (normal range: 74+/-15), the LVEDV is 85 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 35 ml (normal range 47+/-19), the LV mass index is 36 g/m2 (normal range 85+/-15), and the LV mass is 68 g (normal range 164+/-36). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. The interatrial septum is aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 115 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 46 ml (normal range 54+/-17).Right AtriumThe right atrium is at least mildly dilated. There is thickening which appears to be contiguous with the RA free wall which takes up contrast on first-pass perfusion, suggesting some component of vascularity. On late gadolinium enhancement imaging, there is partial contrast uptake, the appearance of which is not consistent with thrombus. Native T1 time in the region of this mass is 1280ms (normal myocardium was 1090ms). Of note, this was seen on previous CT Chest performed in March 2015. In the right atrial appendage, however, there is a more rounded density which does not exhibit late gadolinium uptake; this is suggestive of thrombus.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are drain normally into the right atrium. There is compression of the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a 30 x 30 mm nodule in the right lower lobe adjacent to the right costophrenic angle. There is right pleural thickening and nodularity. There is significant mediastinal soft tissue mass present, the largest of which measures 33 x 22mm with compression of the superior vena cava. There are changes consistent with previous sternotomy. There are numerous vertebral body lesions. There are cystic appearing lesions in the liver. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. Suggest review of previous CT imaging for more detailed description.
1. Normal sized left ventricle with normal systolic function (EF 58%).2. Normal sized right ventricle with normal systolic function (EF 60%).3. There is thickening which appears to be contiguous with the RA free wall which takes up contrast with first-pass perfusion, suggesting some component of vascularity. On late gadolinium enhancement imaging, there is partial contrast uptake, the appearance of which is not consistent with thrombus but the etiology of the mass is otherwise difficult to discern. Native T1 time in the region of this mass is 1280ms (normal myocardium was 1090ms). 4. In the right atrial appendage there is a more rounded density which does not exhibit late gadolinium uptake; this is suggestive of thrombus.5. Mild aortic regurgitation. 6. Mild biatrial dilation. 7. This constellation of findings suggest thrombus within the right atrial appendage. Given the clinical history of metastatic neuroendocrine disease, as well as evidence of partial vascularity of the mass and differential tissue characteristics from myocardium, differential diagnosis for the RA free wall finding includes malignant invasion of the RA wall versus thickening of the RA wall. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.