Abstract
Right atrial appendage aneurysms (RAAAs) are rarely encountered. If symptomatic, they present with atrial arrhythmias or embolic events. Surgical resection is indicated for symptomatic patients. We describe a 65-year-old man presenting with palpitation for 6 months. Electrocardiogram showed atrial flutter. Transthoracic echocardiography revealed a large thin-walled cystic mass anterior to right ventricular outflow tract, which was confirmed to be a giant RAAA by contrast transoesophageal echocardiography and later by contrast-enhanced computerised tomography. The patient underwent electrocardioversion, following which he remained in sinus rhythm and was asymptomatic during the 3 months follow-up period. LEARNING POINTS: RAAA can present with atrial flutter.Transoesophageal contrast echocardiography is the most valuable non-invasive tool in diagnosis of RAAA.Although computed tomography scan is not necessary for establishing the diagnosis, it may provide useful information regarding the structural anatomy.