A 60-year-old woman presented with worsening exertional dyspnoea. She had been having intermittent right heart failure symptoms for 2 years prior to our assessment; however, her functional capacity had recently shown significant deterioration.
An echocardiogram revealed a large right atrial mass measuring 63 × 47 mm, which was almost completely occluding the tricuspid valve ( Fig. 1 ). The IVC was also occupied by the mass, with faint flow between the mass and the IVC wall. Contrast-enhanced computed tomography of the chest and abdomen showed a highly enhanced, 10 cm mass with central necrosis in the right suprarenal region ( Fig. 2 ) on arterial phase. The mass extended into the right hepatic vein and the right atrium. Intraluminal thrombi from the suprarenal segments of the IVC to both femoral veins were observed. The liver was congested due to outflow obstruction. A small amount of ascites was also observed. The mass was successfully resected under circulatory arrest. The patient was weaned from the cardiopulmonary bypass successfully; however, her vital signs became unstable repeatedly, even with full inotropic support and, unfortunately, she did not survive. Laboratory studies and pathology were consistent with pheochromocytoma.
