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- Received April 22, 2009
- Accepted April 29, 2009
- Published online February 23, 2010.
A 76-year-old man presented with 2 months of dyspnea, early satiety, and lower extremity edema. Ten years previously, he underwent left extrapleural pneumonectomy for mesothelioma but had chest wall and mediastinal recurrences that required systemic chemotherapy and local radiation. Transthoracic echocardiography revealed right atrial dilation with a 4.9 × 6.4 cm mass attached to the anterior and inferior right atrial walls (A). Cardiac magnetic resonance imaging demonstrated 2 right atrial masses with gadolinium enhancement indicating vascularity: a 5.2 × 4.7 cm mass on the superior free wall, and a 4 × 4 cm mass partially obstructing inferior venal caval inflow on the lateral free wall (B). Right ventriculography (C)and echocardiographic-guided biopsy (pulmonary artery) (D)were performed (Online Videos 1, 2, 3and 4). Histopathology confirmed the diagnosis of epithelioid-type mesothelioma (hematoxylin and eosin [H&E] stain, E, left; WT-1 stain positive for calretinin, E, right). The patient was not a candidate for surgical resection and died of progressive metastatic mesothelioma.
- Received April 22, 2009.
- Accepted April 29, 2009.
- American College of Cardiology Foundation