Disseminated tuberculosis – diagnostic challenges of atrial tuberculoma masquerading as atrial myxoma

The Journal of the Royal College of Physicians of Edinburgh. 2017;47(4):353-355 DOI 10.4997/JRCPE.2017.410

 

Journal Homepage

Journal Title: The Journal of the Royal College of Physicians of Edinburgh

ISSN: 1478-2715 (Print); 2042-8189 (Online)

Publisher: Royal College of Physicians of Edinburgh

LCC Subject Category: Medicine: Medicine (General)

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF

 

AUTHORS

A Alaga
YX Yew
MK Razul

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 20 weeks

 

Abstract | Full Text

A 47-year-old female, with multiple comorbidities, presented with a cough of two months, loss of weight and appetite. She was treated for pneumonia. A chest X-ray showed bilateral reticulonodular opacities. She was noted to have a vague central abdominal mass and a systolic murmur over the mitral region. Ultrasonography and computed tomography of the abdomen showed an omental mass and loculated ascites. Oesophagoduedenoscopy showed antral gastritis and during colonoscopy the surgical team was unable to advance the scope beyond 40 cm due to external compression. An echocardiogram showed a right atrial mass and a pericardial effusion over the posterior wall. A possible diagnosis of atrial myxoma was made. Sputum acid-fast bacillus was negative. The patient was treated empirically for disseminated tuberculosis and scheduled for bronchoscopy by the pulmonology team. The patient showed remarkable improvement after day 7 of anti-tuberculosis medication. GeneXpert study came back as positive. CT abdomen and echocardiogram repeated after 2 weeks of treatment showed reduction in the mass.