Right atrial intramural hematoma associated with aortic dissection

A 75-year-old male presented with shortness of breath and abdominal pain; he had undergone coronary artery bypass graft surgery three months ago and had a history of coronary artery disease, hypertension, and end-stage renal disease. Transthoracic echocardiogram showed a right atrial mass. A computed axial tomography scan showed an atrial mass and type A aortic dissection. The patient sustained cardiorespiratory arrest and died. An autopsy showed an 8 cm atrial intramural hematoma originating from a dissecting aneurysm. This is the first case of right atrial intramural hematoma associated with aortic dissection exhibiting high mortality. Early diagnosis using multiple imaging modalities including magnetic resonance imaging and timely surgical intervention may improve survival. Intramural hematomas should be considered in patients presenting with right-sided cardiac lesions.