Spectral computed tomography (SCT) for the characterization of cardiac masses: Is magnetic resonance imaging domain over?

We present a case of a patient in his seventies who experienced recurrent pericardial effusion and exertional dyspnea, initially attributed to an episode of pericarditis. Further investigation revealed marked and diffuse thickening of the right atrial walls, raising suspicion of cardiac mass. Spectral CT (SCT) coronary angiography with delayed phase, cardiac magnetic resonance, 18FDG-PET (Positron Emission Tomography) and histopathological analyses were performed. The findings were consistent with atrial pseudotumor from Erdheim-Chester disease (ECD), a rare non-Langerhans cell histiocytosis. This case highlights the added value of SCT and spectral reconstructions in characterizing cardiac masses and the importance of integrating SCT into diagnostic and therapeutic pathways.