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Image challenge
Right atrial mass
  1. Swasthi S Kumar,
  2. Sudipta Mondal,
  3. Vishnu Kesavan
  1. Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  1. Correspondence to Dr Sudipta Mondal, Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India; sudiptamondalnrs{at}gmail.com

https://doi.org/10.1136/heartjnl-2023-323588

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    Clinical introduction

    A middle-aged patient with well-controlled hypothyroidism presented with exertional dyspnoea for a few years. General and systemic examinations were within normal limits. The ECG and chest X-ray were essentially normal. A transthoracic and transoesophageal echocardiogram are shown in figure 1A–C, online supplemental videos 1–3. Ventricular function was normal, with no significant valvar stenosis or regurgitation.

    Supplementary video

    [heartjnl-2023-323588supp001.avi]

    Supplementary video

    [heartjnl-2023-323588supp002.avi]

    Supplementary video

    [heartjnl-2023-323588supp003.avi]
    Figure 1

    (A) Two-dimensional transthoracic echocardiogram in apical four-chamber view; (B) 2D-transoesophageal echocardiogram in mid-oesophagal 117 degrees and 0 degrees (C) long-axis view. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

    Question

    What is the next best step in the management?

    1. Cardiac magnetic resonance imaging (CMRI)

    2. Anticoagulation for 3 months and re-imaging

    3. Transcatheter biopsy

    4. Cardiac CT

    Answer: A

    A transthoracic echocardiogram (TTE) revealed a hyperechoic mass of 8×6 mm attached to the lateral wall of the …

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    Footnotes

    • Twitter @Sudiptanrs, @vishnukesavan2k7

    • Contributors SSK (conceptualisation: equal; formal analysis: equal; writing—original draft: equal; writing—review and editing: equal); SM (conceptualisation: equal; formal analysis: equal; writing—original draft: equal; writing—review and editing: equal); VK (conceptualisation: equal; formal analysis: lead; writing—review and editing: lead).

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.