Massive Lipomatous Hypertrophy of the Right Atria
A 70-year-old female with a history of hypertension, atrial fibrillation, pacer implantation for symptomatic bradycardia, and a prior cerebrovascular accident was transferred to our institution for further evaluation and management of a recently identified persistent methicillin-sensitive Staphylococcus aureus bacteremia.\nDuring workup of her bacteremia, a transesophageal echocardiogram was requested to rule out the presence of endocarditis. Although no vegetations were seen on either pacer wires or cardiac valves, a massive homogeneous thickening of the superior portion of the interatrial septum was noted [ and ]. This mass effect extended to the posterior and roof portions of the right atrial wall as well as to the superior vena cava, causing proximal compression of this vessel [Figure and ]. In view of these findings, a chest computed tomographic examination was requested for better definition of this mass density. Following contrast administration, the mass effect noted by transesophageal echocardiography was identified as intrapericardial fat density that extended toward the interatrial septum without evidence of infiltration of the interatrial septum directly []. Additionally, a nodular opacity was also found in the lateral left upper lobe with a greatest diameter of 1 cm that was thought to be a potential septic embolus given the recent history of bacteremia (not shown).\nThe initial continuous infusion of Nafcillin was later changed to Oxacillin, as surveillance blood cultures were all negative. The plan was to remove her transvenous pacer and replace it once she had completed her antibiotic therapy and follow-up blood cultures off antibiotics remained negative.