A 59-year-old Hispanic lady with history of rheumatic fever and chronic atrial fibrillation presented to the emergency department with severe dyspnea. Seventeen years prior to this presentation, she had undergone re-do mitral valve replacement, and tricuspid annuloplasty. The patient’s chest radiograph revealed massively dilated right chambers of the heart (Figure 1). An electrocardiogram showed right axis deviation, atrial fibrillation with a controlled heart rate of 70 beats per minute. A chest computed tomography (CT) scan revealed a gigantic right atrium measuring approximately 12 cm in its largest diameter (Figure 2).
These images are relevant because this reveals one of the few cases of massively dilated right atrium, despite previous mitral valve replacement and tricuspid annuloplasty. Other etiologies of a dilated right atrium in patient with dyspnea in the ED and intensive care unit (ICU) include: chronic obstructive pulmonary disease, tricuspid valvular stenosis, severe mitral valvular pathology with pulmonary hypertension, chronic pulmonary emboli, and untreated congenital heart disease.
Salim Surani, Arif Surani, Joseph Varon
