38 year old with history of NICM s/p heart transplant in may 2015, hypertension, gout and pericarditis. Referred for cardiac CT to better delineate right atrial mass seen on cardiac MRI 11/17/16.CPT Code: 75574 (AP) Coronary arteries: This study was not optimized for the visualization of the coronary vasculature.LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove. LCx: The left circumflex coronary artery courses normally in the left AV groove.RCA: The right coronary artery arises normally from the right sinus of valsalva.Left Ventricle: The left ventricular late diastolic volume is normal.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits. Epicardial pacer wires are noted on the right ventricle.Left Atrium: Visually, the left atrial volume has transplant morphology. There are five distinct pulmonary veins (3 on right, 2 on left) which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. There is a well defined/ circumscribed right atrial mass 17x15x11 mm in size with a thin stalk which is attached near the tip of the eustachian valve. Although the differential diagnosis includes a variety of cardiac masses including vegetation and myxoma, I suspect it is most likely a thrombus. It is unlikely to be a malignant tumor based on its morphology. The superior vena cava is dilated because there is azygous continuation of the inferior vena cava. The hepatic veins drain directly into the right atrium. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The main pulmonary artery is normal in size.Pericardium: There is a small pericardial effusion. Epicardial pacing wires are noted.
1.There is a well defined/ circumscribed right atrial mass 17x15x11 mm in size with a thin stalk which is attached near the tip of the eustachian valve. Although the differential diagnosis includes a variety of cardiac masses including myxoma and vegetation, I suspect it is most likely a thrombus. It is unlikely to be a malignant tumor based on its morphology. The mass is new from 4/19/2016 cardiac MRI.2.The superior vena cava is dilated because there is azygous continuation of the inferior vena cava which does not drain directly into the right atrium. The hepatic veins drain directly into the right atrium. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.