Right heart serpiginous mass

Excerpt

A 62-year-old man with hypertension, CKD (stage 3), and HIV presented with 2 weeks of worsening dyspnea and syncope. He was tachycardic with normal blood pressure. ECG showed sinus tachycardia. Transthoracic echocardiogram showed a large, mobile, multilobular mass in the right atrium, consistent with a thrombus, prolapsing into the right ventricle [Figs. 1 and 2, video 1 (supplementary material)]. There was right atrial enlargement, severe RV enlargement, and dysfunction (the right ventricular fractional area change was severely abnormal at 14 %) and normal LV systolic function. The tricuspid inflow velocities were normal. Estimated pulmonary artery pressure was 55 mmHg. A ventilation-perfusion scan revealed bilateral pulmonary emboli.

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