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.