Isolated Right Atrial Mass in a Candidate of Coronary Bypass Grafting

Abstract

Hepatocellular carcinoma (HCC) is not uncommon neoplasm, and its occurrences with coronary artery disease (CAD) is more confronted by cardiac surgeon today. In most cases, when the HCC is detected, it has invaded to regional or distant sites. The most frequent location of HCC metastasis includes pulmonary system, musculoskeletal, lymphatic system, and central nervous system. Indeed, intra-atrial metastasis is a rare phenomenon and associated with poor outcome. We report a case of CAD with known HCC that referred for CABG before scheduling for hepatic tumor management. His severe typical chest pain, aggravated by mild activity so his abdominal pain is shadowed by chest pain. The abdominal ultrasound revealed a large mass in the left hepatic lobe. Chest x-ray was unremarkable. Routine preoperative transthoracic echocardiography (TEE) exhibits a large sessile mass in the right atrium. The patient underwent combined resection of right atrial mass and off-pump coronary artery bypass grafting. The most of HCC patients with RA involvement usually presenting with lengthy thrombus that continues from vascular invasion site to RA, however, as in our patient, isolated and sole metastasis to RA is an exceptional phenomenon in HCC. The clinical postoperative course was uneventful, and the patient discharged on the 10^th day of operation. The six-month follow-up revealed no recurrence of right atrial mass when the patient completed his treatment by hepatic lobectomy and combined adjuvant chemotherapy.