A 65-year-old woman with prior hysterectomy reported 6 months of abdominal distension refractory to paracentesis. Severe dyspnea prompted computed tomography (CT) pulmonary artery angiography, which excluded pulmonary embolism but revealed giant right atrium (RA) (Figure, A). The differential diagnosis of giant RA includes pulmonary hypertension and congenital anatomical disorders that increase cardiac preload.1 Catheterization excluded pulmonary vascular disease; however, cardiac magnetic resonance imaging suggested left-to-right shunt, manifest by increased pulmonary to systemic blood flow (Qp/Qs ratio, 1.8). Reanalysis of the CT images showed an anomalous connection involving the left pulmonary vein (blue arrowhead) and left brachiocephalic vein (red arrowhead) (Figure, B).
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Published Online: April 5, 2023. doi:10.1001/jamacardio.2023.0363
Corresponding Author: Bradley A. Maron, MD, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, 77 Ave Louis Pasteur, NRB 0630-N, Boston, MA 02115 (email@example.com).
Conflict of Interest Disclosures: Dr Maron reported receiving grants from the National Institutes of Health, Massachusetts Institute of Technology–Broad Institute, and Cardiovascular Medical Research Foundation outside the submitted work. No other disclosures were reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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