https://orcid.org/0000-0001-9958-1340
A 56-year-old man presented with superior vena cava syndrome after recovery from severe COVID-19. Chest X-rays showed multiple bilateral pulmonary nodules (Panel A). A transthoracic echocardiogram revealed a mass in the right atrium of 54 × 31 mm, that protruded through the tricuspid valve and generated an obstructive gradient of 15 mmHg (Panel B; Supplementary Video 1). Contrast-enhanced chest computed tomography (CT) showed multiple pulmonary nodules (Panel C), and an intravascular extension of the intracardiac mass, deep into the innominate veins (Panels D and E). Volume 3D rendering CT showed extensive collateral venous circulation (Panel F). Steady-state free precession cine magnetic resonance imaging sequence showed an isointense mass with hyperintense areas in the right atrium, that measured 6.8 × 6.3 × 3.8 cm and prolapsed through the tricuspid valve (Panel G; Supplementary Video 2). The intracardiac mass was T1- and T2-weighted hyperintense (Panels H and I). Additionally, a mediastinum mass of 25 × 26 mm was found, with similar characteristics than the intracardiac mass.
Surgery was performed, with resection of a 70 × 50 mm mass of mucinous characteristics, located in the right atrium (Panel J). The superior vena cava was found to be occluded by mucinous tissue. Histopathologic examination showed a lobulated configuration with a lymphocyte-rich background, interspersed with larger cells with an epithelioid appearance (Panel K). These cells were positive for cytokeratin (AE1/AE3) and P63, and the background lymphocytes were positive for terminal deoxynucleotidyl transferase (TDT) (Panels L and M). A Type B2 thymoma was confirmed. Positron emission tomography revealed tumoural activity in mediastinum and pulmonary nodules. The patient received palliative chemotherapy with carboplatine and paclitaxel.
Supplementary data are available at European Heart Journal - Cardiovascular Imaging online.
Consent: Patient consent was obtained for this case report.
Data availability: The data that support the findings of this study are available from Instituto Nacional de Cardiologia but restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Instituto Nacional de Cardiologia.
Author notes
Conflict of interest: None declared.
