case_images: PMC9957568_01
case_images: A right atrial mass was incidentally noted on initial transthoracic echography.
case_images: cureus-0015-00000034202-i01.jpg
case_images: PMC9957568_01_cureus-0015-00000034202-i01.jpg
case_images: FIG1
case_images: As part of his initial workup, a transthoracic echocardiogram (TTE) was obtained, which reported a mildly depressed right ventricular systolic function with a right ventricular systolic pressure that is consistent with critical (near systemic) pulmonary hypertension (RVSP 94 mmHg) and a moderately dilated right atrium with an incidental mass found sitting in the right atrium (Figure 1).
case_images: Persistence of right atrial mass post-thrombolysis with alteplase on repeat transthoracic echography.
case_images: cureus-0015-00000034202-i02.jpg
case_images: PMC9957568_01_cureus-0015-00000034202-i02.jpg
case_images: FIG2
case_images: TTE post-thrombolysis still revealed no change and persistence of the echodensity in the right atrium (Figure 2), raising suspicion for an alternate right atrial mass vs. a thrombus. This prompted the urgent transfer of this patient to our academic tertiary care centre for further evaluation.
case_images: View of a calcified right atrial thrombus via transesophageal echography.
case_images: cureus-0015-00000034202-i03.jpg
case_images: PMC9957568_01_cureus-0015-00000034202-i03.jpg
case_images: FIG3
case_images: To better define the characteristics of the right atrial echogenicity and interatrial septum, we proceeded to perform transoesophageal echocardiography (TEE), which noted a partially calcified irregular serpiginous/elongated mass with multiple prongs, extending from the superior vena cava into the right atrium and not involving the inferior vena cava, right atrial appendage, or tricuspid valve (Figure 3), most likely avascular on the contrast study, and the entire structure was not visualised on the Definity contrast study.