Extract

A patient with a right upper lobe lung mass presented with a stroke and peripheral embolism. A left atrial mass prolapsing through the mitral valve was seen on transthoracic echocardiogram, but it remained undiagnosed. Transoesophageal echocardiography (TEE) enabled the origin of the left atrial mass (Panels A and B, Supplementary data, Video 1) to be traced to the right upper pulmonary vein. Doppler interrogation of the right upper pulmonary vein suggested a total occlusion. The elongated, multilobular, friable appearance, and the origin of the mass from the pulmonary vein (Panels C and D, Supplementary data, Video 2) allowed it to be distinguished from alternative causes of a mobile mass prolapsing across the mitral valve such as left atrial myxoma, thrombus, or infection.

The patient died of an extension of cerebral infarction and a post-mortem confirmed that the aetiology of the left atrial mass was due to primary lung tumour invasion into the right upper pulmonary vein and its extension into the atrium. Histology showed primary mesenchymal chondrosarcoma of the lung, a rare tumour normally found in soft tissue.

You do not currently have access to this article.