A 60-year-old female patient started to complain since two months of low grade fever of unknown origin associated with anorexia, generalized malaise and weight loss. On presentation, the patient’s central venous pressure was elevated with systolic collapse; cardiac examination revealed pansystolic murmur over the lower end of the sternum associated with mid-diastolic short murmur with no other remarkable findings in clinical examination. No abnormalities were detected in the chest X-ray and electrocardiogram showed normal sinus rhythm with no other specific changes.
Transthoracic echocardiography revealed large oval mass (measuring 5 × 6 cm) occupying most of the right atrial cavity and prolapsing into the right ventricle, and associated with significant tricuspid incompetence ( Fig. 1 A–C ). The mass was attached with a pedicle to the right atrium posterior wall close to the coronary sinus and IVC opening as demonstrated by cardiac CT scan ( Fig. 1 D).
