ELUSIVE INTRACARDIAC MASS ASSOCIATED WITH MALIGNANCY AND HORMONE USE

Abstract

A 63-year-old woman presented to the emergency room with an episode of fatigue, confusion, blurred vision, and inability to move her right arm. Computed Tomography (CT) of the chest showed bilateral pulmonary emboli. Magnetic Resonance Imaging (MRI) of the brain showed a small acute infarct in the left parietal cortex. Transthoracic echocardiography revealed a right atrial mass which was further evaluated by transesophageal echocardiography (TEE), which confirmed a large, extremely mobile mass measuring 3 x 0.5 cm extending from the inferior vena cava to the right atrium. Her medical history and diagnostic findings of ovarian malignancy suggested a hypercoagulable state and high likelihood of an intracardiac thrombus. Surgery was contemplated to prevent further embolic events given the size and mobility of the intracardiac cardiac mass. Prior to surgery, patient was started on intravenous (IV) Heparin to prevent further embolic events. A pre-operative TEE done after 4 days of IV Heparin showed complete disappearance of the mass in the right atrium, thus obviating the need for surgery.