Solid intracardiac mass complicating peritoneovenous shunting

A 62-year-old man with liver cirrhosis and esophageal varices had received a peritoneovenous shunt (Denver shunt) in 1997. He was then re-admitted in 2005 with the clinical signs of recurrent ascites formation. The presence of a large intracardiac mass at the tip of the Denver shunt was demonstrated and the patient was referred to us for surgical removal of what was believed to represent a large right atrial thrombus potentially obstructing the shunt. After opening of the right atrium, a solid intracardiac mass at the tip of the Denver shunt was found, extending across the tricuspid valve and into the right ventricular cavity. After resection of the mass at its tip and appropriate shortening, the Denver shunt appeared to be patent. On histopathologic examination, the resected mass appeared as calcified fibrosis with hyalinized collagen fibers. However, later it was determined that ascites drainage by means of the Denver shunt remained insufficient and the patient received a transjugular intrahepatic portosystemic shunt (TIPS), which has improved his condition since then.