Key result
Systemic thrombolysis fails to resolve a right atrial mass linked to a left kidney tumor.
Why the study?
A solid mass in the right atrium after systemic thrombolysis for massive pulmonary embolism requires characterization to distinguish thrombus from tumor.
Case Report (n=1)
This case highlights the use of multimodality imaging to identify a free-floating right atrial mass associated with a renal tumor and IVC infiltration in a patient presenting with massive pulmonary embolism.
May prompt renal imaging in unexplained mobile right atrial masses with PE; leaves open the diagnostic value of multimodality protocols.
A 63-year-old woman with a history of breast cancer in 2005 and a synovial carcinoma of the left lung with resection of the lingula in November 2013 and the upper left lobe in January 2014 was transferred to our coronary care unit from a secondary regional hospital after systemic thrombolysis for a massive pulmonary embolism. Transthoracic echocardiography revealed a solid mass of 3 × 3 cm in the right atrium (Panel A, Supplementary Data), which was confirmed by a CT scan (Panel B). It was first suspected to be a thrombus, but did not resolve after lysis. The computed tomography (CT) scan showed a tumour of the left kidney of unknown origin with infiltration of the inferior vena cava. Transoesophageal echocardiography was performed and confirmed a 3 × 3 cm highly mobile, solid mass without any attachment with the right atrial wall (Panel C,Supplementary Data). Furthermore, there was no connection between the mass and the almost completely occluded inferior vena cava.
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Klug et al. (2015) conducted a case report in Right atrial mass and massive pulmonary embolism (n=1). Systemic thrombolysis was evaluated on Resolution of the right atrial mass. A 3x3 cm solid mass in the right atrium of a 63-year-old woman did not resolve after systemic thrombolysis and was found to be associated with a left kidney tumor.
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