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A 65-Year-Old Woman With Dyspnea and Recurrent Abdominal Distension

To identify the key insights or developments described in this article
1 Credit CME

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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Article Information

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 (bmaron@bwh.harvard.edu).

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.

References
1.
Ariyarajah  V , Soni  A , Morris  A .  Giant right atrium in an adult.   Echocardiography. 2008;25(10):1121-1123. doi:10.1111/j.1540-8175.2008.00742.xPubMedGoogle ScholarCrossref
2.
Martinez-Jimenez  S , Heyneman  LE , McAdams  HP ,  et al.  Nonsurgical extracardiac vascular shunts in the thorax: clinical and imaging characteristics.   Radiographics. 2010;30(5):e41. doi:10.1148/rg.e41PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

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.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

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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