We report the case of a 58-year-old hypertensive man referred for a cardiology consultation due to atypical chest pain. The clinical examination was unremarkable. An electrocardiogram demonstrated sinus rhythm and incomplete right bundle branch block. He had an ambulatory echocardiogram that was described as normal. An exercise test was negative for ischemia and showed intermittent complete right bundle branch block. To exclude coronary disease a contrast computed tomography (CT) scan was performed that revealed a saccular aneurysm of the lateral free wall of the right atrium measuring 45 mm×45 mm×43 mm (Figures 1 and 2). There was no evidence of coronary disease. Given the CT findings, transthoracic echocardiography was repeated and revealed a cystic, pulsatile structure in continuity with the free wall of the right atrium through a narrow neck (Figure 3) permitting low-speed two-way flow, subsequently confirmed by injection of Sonovue® contrast. No cardiac thrombi were visualized. The tricuspid valvular apparatus and right ventricle were morphologically normal, as was biventricular systolic function. Similar findings were visualized on the transesophageal echocardiogram.

Figure 1.

Computed tomography (CT) scan, axial view. LA: left atrium; LV: left ventricle; RA: right atrium; RAA: right atrial aneurysm; RV: right ventricle.

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Figure 2.

CT scan: three-dimensional reconstruction of the right atrial aneurysm (RAA).

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Figure 3.

Transthoracic echocardiogram, apical 4-chamber view. LA: left atrium; LV: left ventricle; RA: right atrium; RAA: right atrial aneurysm; RV: right ventricle.

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Right atrium aneurysm is a rare congenital heart malformation. It occurs in all age groups. Supraventricular arrhythmias and embolic events are the most common reported symptoms. Major complications such as rhythm disturbances, thromboembolic events and aneurysm rupture may occur. Although the best treatment, particularly in asymptomatic patients, has not been established, the patient was started on oral anticoagulation and proposed for surgical aneurysmectomy. He underwent successful resection of the aneurysm (Figure 4) with an uneventful post-operative period.

Figure 4.

Intraoperative photograph (surgeon's view) revealing the right atrial aneurysm (RAA).

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