The

n e w e ng l a n d j o u r na l

of

m e dic i n e

Images in Clinical Medicine

Lindsey R. Baden, M.D., Editor

Enlarged Right Atrium

A

RV
RA
LV
LA

RA

57-year-old man presented to the emergency department with Bijan Jahangiri, M.D.
peripheral edema. Findings on physical examination were consistent with O. Christopher Raffel, M.B., Ch.B.
atrial fibrillation, tricuspid regurgitation, and heart failure on the right Prince Charles Hospital
side. A radiograph of the chest showed a high cardiothoracic ratio of 0.82 and a Brisbane, QLD, Australia
very large right atrium (RA; Panel A). Transthoracic echocardiography (Fig. S1 in drbijan@yahoo.com
the Supplementary Appendix, available at NEJM.org), cardiac computed tomography (Panel B, and Figs. S2 and S3 in the Supplementary Appendix), and cardiac
magnetic resonance imaging (Fig. S4 in the Supplementary Appendix) revealed a
giant right atrium, a dilated right ventricle (RV) with preserved systolic function,
grade 4/4 functional tricuspid regurgitation, high-normal right-ventricular systolic pressure, and normal size and function of the left ventricle (LV). LA denotes
left atrium. No shunt was identified. Medical therapy, including oral anticoagulation for atrial fibrillation, was initiated, with good response, and the patients
condition remained stable 1 year after presentation. Giant right atrium is a rare
congenital condition that causes functional tricuspid regurgitation and heart
failure on the right side. It is usually diagnosed in childhood. Other, more common
causes of right atrial enlargement such as pulmonary hypertension, tricuspidvalve stenosis, and Ebsteins anomaly were not identified in our patient.

DOI: 10.1056/NEJMicm1513588
Copyright 2016 Massachusetts Medical Society.

n engl j med 375;6

nejm.org

August 11, 2016

The New England Journal of Medicine

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Copyright 2016 Massachusetts Medical Society. All rights reserved.

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