Cor triatriatum dexter.

Abstract

A 68-year-old woman presented with cellulitis of the left leg. She had a history of hypertension, obesity, and chronic lymphedema of the lower left leg. On admission, roentgenography of the chest showed possible cardiomegaly, but other cardiovascular findings were normal. An initial transthoracic echocardiogram was thought to show a right atrial mass that measured 1.2 × 1.6 cm (Fig. 1). The suspected mass appeared to arise from the interatrial septum. Transesophageal echocardiography (Fig. 2) showed a normal right atrium. An unusually prominent eustachian valve arose normally from the ostium of the inferior vena cava and was attached to the interatrial septum just below the level of the fossa ovalis (Figs. 2 and ​and3).3). The valve measured 1.2 × 2.6 cm in its greatest thickness and partitioned the right atrium into roughly 2 chambers (Figs. 4 and ​and5).5). Intravenous saline contrast injection (Fig. 5) showed partitioning of the right atrium into 2 chambers by this membrane. Inferior vena caval flow was not obstructed. These findings were consis-tent with cor triatriatum dexter. Fig. 1 Transthoracic echocardiogram in 4-chamber view shows the right atrial mass (arrowhead). Fig. 2 Transesophageal echocardiogram in 4-chamber view shows a prominent eustachian valve (arrowhead) attached to the interatrial septum just below the level of the fossa ovalis. Fig. 3 Transesophageal echocardiogram shows the eustachian valve viewed from the superior vena cava. Fig. 4 Transesophageal echocardiogram in the color-flow Doppler short-axis view shows flow across the membrane (arrowhead). Fig. 5 Transesophageal echocardiographic bubble study shows partitioning of the right atrium into 2 chambers.