case_images: PMC10905209_01
case_images: Chest x-ray on admission. Cardiomegaly was noted with left retrocardiac opacity.
case_images: cureus-0016-00000053333-i01.jpg
case_images: PMC10905209_01_cureus-0016-00000053333-i01.jpg
case_images: FIG1
case_images: Chest x-ray showed an enlarged cardiac silhouette (Figure 1).
case_images: Electrocardiogram on admission. Poor R wave regression and inferolateral ST-elevation were noted.
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case_images: PMC10905209_01_cureus-0016-00000053333-i02.jpg
case_images: FIG2
case_images: An electrocardiogram (EKG) revealed ST-segment elevations in the inferolateral leads (Figure 2).
case_images: Left heart catheterization and coronary angiography. (A) The left anterior oblique image showed normal coronary arteries without obstruction. (B) The right anterior oblique image showed normal right coronary arteries without obstruction (red arrow). It also showed increased vascularity at the distal aspect of the right coronary artery (black arrows).
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case_images: PMC10905209_01_cureus-0016-00000053333-i03.jpg
case_images: FIG3
case_images: Increased vascularity was noted at the distal aspect of the right coronary artery, which would lead to the right ventricular (RV) apex (Figure 3).
case_images: Transthoracic echocardiogram apical four-chamber view. Transthoracic echocardiogram apical four-chamber view showed a heterogenous irregularly shaped mass adjacent to the right ventricle apex.
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case_images: PMC10905209_01_cureus-0016-00000053333-i04.jpg
case_images: FIG4
case_images: Serial echocardiograms were obtained, demonstrating improved effusion, with persistent 4.5 cm x 4 cm heterogenous irregularly shaped mass visualized attached to the right ventricular apex (Figure 4).
case_images: Cardiac magnetic resonance imaging. Magnetic resonance imaging cine longitudinal relaxation time (T1) imaging of the (A) four-chamber view and (B) two-chamber view showed a 6 cm x 5 cm intrapericardial mass adjacent to the right ventricle apex without clear demarcation between the right ventricle free wall and mass. (C) Magnetic resonance imaging cine longitudinal relaxation time (T1) imaging of the short axis showed an intrapericardial mass anterior to the right ventricle outflow tract/pulmonary artery.
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case_images: PMC10905209_01_cureus-0016-00000053333-i05.jpg
case_images: FIG5
case_images: Once drain output had diminished to zero, and echocardiographic stability of effusion was noted, the drain was removed, and cardiac MRI was obtained, which revealed multiple masses visualized in the pericardium, one mass anterior to the right ventricular outflow tract (RVOT)/pulmonary artery (PA) and a second mass adjacent to the RV apex, which was measured to be 6 cm x 5 cm (Figure 5).
case_images: Positron emission tomography (tumor image). Positron emission tomography showed a (A) small hypermetabolic mass in the left upper lobe (standardized uptake values max of 8.7); (B) hypermetabolic central left hilar mass (standardized uptake values max of 15.6); (C) large hypermetabolic mass adjacent to the inferior apical border of the heart (standardized uptake values max of 15.8) and a hypermetabolic mass in the infrahilar left lower lobe (standardized uptake values max of 16.2); and (D) left intrahilar, left hilar, and left cardiophrenic masses with associated hypermetabolic right hilar, left hilar, subcarinal, costophrenic, aortopulmonary, paratracheal and mediastinal lymphadenopathy. No evidence of bone marrow lesions was noted.
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case_images: FIG6
case_images: The patient underwent positron emission tomography (Figure 6) scan, which revealed left intrahilar, hilar, and cardiophrenic masses with associated hypermetabolic right hilar, left hilar, subcarinal, costophrenic, aortopulmonary, paratracheal, and mediastinal lymphadenopathy.