Get Closer to the Diagnosis in a Flash

A 15-year-old girl of Middle East origin was seen by a pediatrician because of suspected pituitary nanismus. That diagnosis was quickly ruled out; however, a supposedly innocent systolic cardiac murmur resulted in referral to echocardiography. She had no cardiopulmonary symptoms, but the examination revealed a large nonobstructive, mobile, and apparently multicystic mass in the right ventricle (Figure 1). The mass was located close to the tricuspid valve with a stalk to a papillary muscle. Color Doppler imaging did not show any flow in the tumor (Figure 2; also see online-only Data Supplement Movie clips).Figure 1. Echocardiography. A , Apical 5-chamber view showing the attachment of the mass (M) to a papillary muscle in the right ventricle. B and C are parasternal long-axis and short-axis views, respectively. In these views, the multicystic appearance of the mass is clearly seen. AO indicates aorta; LA, left atrium; LV, left ventricle; and RA, right atrium.Figure 2. Echocardiographic image with color Doppler. The velocity scale is adjusted to 49 cm/s. There is no flow in the cardiac mass. Lower color flow velocities gave aliasing artifacts in …