Multimodality Imaging in an Unusual Case of Palpitations and Right Heart Failure

A 73-year-old woman presented with palpitations and right heart failure. Physical examination revealed elevated jugular venous pulse with a pansystolic murmur. ECG showed atrial flutter with a right bundle-branch block (Figure 1). A chest X-ray revealed normal cardiac size with a superior mediastinal opacity consistent with a goitre (Figure 2). Transthoracic and transoesophageal echocardiography demonstrated a large intramyocardial mass in the right ventricular freewall measuring up to 7.5×5 cm associated with right ventricular and right atrial dilatation, and systolic dysfunction (Figure 3A and B and online-only Data Supplement Movie I). The tricuspid valve was thickened with impaired leaflet mobility, resulting in severe tricuspid regurgitation (online-only Data Supplement Movie II). Tests to characterize the mass and to investigate other primary tumors were undertaken. A computed tomography scan confirmed a cardiac mass, a goitre, a small adrenal …