Echocardiography Bubble Test Reveals Rare Giant Right Atrial Appendage Aneurysm

Right atrial appendage aneurysm (RAAA) is a rare cardiac anomaly that may be misdiagnosed as Ebstein anomaly, right atrial wall aneurysm, right atrial diverticulum, or pericardial cyst. Clinical manifestations are nonspecific, and many patients are asymptomatic. Diagnosis often occurs incidentally during imaging or surgical procedures performed for unrelated reasons. In the present case, RAAA was accidentally discovered and initially misdiagnosed as a pericardial cyst on chest CT. Subsequent transthoracic echocardiography (TTE) failed to clearly demonstrate communication between the aneurysm and the right atrium by two-dimensional or color Doppler imaging. However, contrast echocardiography (bubble test) provided higher sensitivity and established the diagnosis.