Esophageal Clot Masquerading as Cardiac Tumor

Purpose: Due to close anatomical relationship between the thoracic esophagus and heart, any aberration in one can lead to manifestations in the other. We aim to present a case of esophageal thrombus masquerading as cardiac tumor. Medline review reveals no previous report of a similar case. A 76 year old woman presented with lower extremity weakness and dizziness. Physical examination was remarkable for limb weakness. Brain MRI/MRA were negative. The patient became hypoxemic and was empirically treated for pulmonary embolus. Echocardiogram revealed a mobile echodensity in the right atrium and a circular structure in close proximity, posterior to the left atrium concerning for pericardiac mass. She was anticoagulated and subsequently vomited 500 cc fresh blood, the hematocrit fell to 13%. Initial endoscopy revealed clot vs. mass involving the proximal esophagus past which the scope could not be passed. Repeat echocardiogram revealed a circular large mass in the posterior aspect of the left atrium which had increased in size and appeared more echodense measuring 2.8 cm × 3.0 cm. Preliminary impression was pericardial tumor. Chest CT showed a dilated, clot filled esophagus. Repeat endoscopy showed severe diffuse esophagitis beneath a large clot with an oozing vessel in the mid-esophagus which was injected with epinephrine and clipped. This time the esophageal clot was successfully washed distally into the stomach. Subsequent echocardiogram showed resolution of previous pericardial tumor. Thus the previously noted pericardial tumor was in fact esophageal clot (Figure 1). Patient did well on high dose esomeprazole and was discharged home. Cardiac tumors are most commonly benign myxoma or malignant sarcomas. Previous, psuedotumors that have been reported include eustachian valves, catheters, lipomatous hypertrophy, thrombi, ridges, cardiac muscles and calcified masses. In conclusion, our case illustrates the importance of the relationship between the two organ systems and the need to be cognizant of that relationship when forming differential diagnosis regarding atrial masses. Lastly, we have illustrated the value of obtaining additional imaging, specifically chest CT in order to arrive at an accurate diagnosis.