Prolapsing Intrigue: A Case of Superior Vena Cava Mass Visualized by Echocardiography From the Subcostal Window Unveiling an Anterior Mediastinal Type B2 Thymoma

Figure 1. Modified short-axis view at the base of the heart from the left parasternal window showing the right atrial mass (blue arrow); but the origin or the attachment of the mass could not be visualized from this view. The lower (juxta-atrial) superior vena cava could not be visualized from this view.

Figure 2. Apical four-chamber view showing the right atrial mass (blue arrow); the origin or the attachment of the mass could not be visualized from this view. The lower (juxta-atrial) superior vena cava could not be visualized from this view.

Figure 3. Apical five-chamber view showing the right atrial mass (blue arrow); the origin or the attachment of the mass could not be visualized from this view. The lower (juxta-atrial) superior vena cava could not be visualized from this view.

Figure 4. Modified subcostal view of the right atrium showing actually that the right atrial mass originated from the lower (juxta-atrial) superior vena cava and is prolapsing into the right atrium. Blue arrow showing the right atrial mass originating from the lower (juxta-atrial) SVC. Red arrow showing the ascending aorta. Yellow arrow showing the liver.

Figure 5. Same modified subcostal view of the right atrium with color coding showing no aliasing of color flow around the right atrial mass originating from the lower (juxta-atrial) superior vena cava, indicating no major obstruction to flow. Blue arrow showing the right atrial mass originating from the lower (juxta-atrial) SVC. Red arrow showing the ascending aorta. Yellow arrow showing the liver.

Figure 6. CT scout view of the chest showing an enlargement of the mediastinum (blue arrows).

Figure 7. Enhanced CT scan of the chest showing a large anterior mediastinal mass (blue arrow).

Figure 8. Enhanced CT scan of the chest showing the anterior mediastinal mass invading the superior vena cava and prolapsing into the right atrium (blue arrow).

Figure 9. Enhanced CT scan of the chest showing a large metastasis to the right upper lobe (blue arrow).

Figure 10. Core needle biopsy being done under CT guidance (blue arrow).

Figure 11. Needle being advanced into the tumor under CT guidance to perform the core biopsy (blue arrow).

Figure 12. Pathology specimen showing thymoma type B2.