We report a case of a man aged 65 years presenting with chronic cough, haemoptysis and intermittent atrial tachyarrhythmias on ECG. On 2D transthoracic echocardiography, an incidental left atrial mass was seen, initially thought to be a thrombus predisposed by intermittent atrial fibrillation. Transoesophageal echocardiography confirmed that this left atrial mass originated from a fixed, non-homogenous, right superior pulmonary vein mass with an extracardiac extension. Because of this finding, a thorough search for a primary focus lead to the discovery of a contiguous posterior mediastinal mass, which was a round cell neoplasm on histology. Management was deemed palliative. Although rare, left-sided cardiac masses should prompt the physician to search for a malignancy in the lung in high-risk patients, as haematogenous spread via the pulmonary vein is a potential mechanism for spread.
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Contributors JLT (corresponding author), an adult cardiology fellow-in-training, was the fellow-in-charge, who, together with his consultant EOS, thoroughly thought of how to decipher the patient's clinical presentation and eventually provided optimum care for the patient. JAMA, an interventional cardiology fellow-in-training and research expert, was vital in providing constructive comments and revisions in the writing of this case report's manuscript. JDM, cardiology consultant and a level 3 echocardiographer, was an inspiration as well as a technical expert in the field of echocardiography, who spearheaded the diagnostic echocardiography which shed light to the proper management in the patient. EOS, cardiology consultant and an interventional cardiologist, was one of the attending physicians of the patient who guided the fellow-in-charge in managing the patient and who was kind enough to have given permission to have this case written and eventually published for contribution in the field of cardiovascular medicine.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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