A Right-Sided Cardiac Mass

A 69-year-old woman experienced recurrent presyncope during a two-week period. Six years previously, a total abdominal hysterectomy with preoperative radium implantation had been performed for stage II uterine carcinoma. The patient was an obese woman who was slightly dyspneic at rest. Her BP was 94/70 mm Hg, her pulse rate was 80 beats per minute, and her respirations were 24/min. The examination findings were otherwise unremarkable. A 12-lead ECG showed sinus rhythm (rate, 80 beats per minute) with a right bundle-branch block. A chest roentgenogram was normal. A technetium Tc 99m albumin aggregated perfusion scan of the lungs demonstrated several bilateral lobar and segmental defects; therapy with intravenous heparin was begun. During the ensuing days, hypotension and episodic cyanosis occurred. On the third hospital day, cross-sectional echocardiography was performed (Fig 1). What is your diagnosis? Diagnosis.—Right Atrial Thrombus. The cross-sectional echocardiogram shows dilated right-sided cardiac chambers. An irregular,