Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1206
Peer-review started: November 16, 2022
First decision: November 30, 2022
Revised: November 30, 2022
Accepted: January 10, 2023
Article in press: January 10, 2023
Published online: February 16, 2023
Processing time: 89 Days and 13.1 Hours
The incidental detection of a right atrial mass during routine cardioncological workup is a rare condition. The correct differential diagnosis between cancer and thrombi is challenging. A biopsy may not be feasible while diagnostic techniques and tools may not be available.
We report the case of a 59-year-old female patient with a history of breast cancer and current secondary metastatic pancreatic cancer. She developed deep vein thrombosis and pulmonary embolism and was admitted to the Outpatient Clinic of our Cardio-Oncology Unit for follow-up. Transthoracic echocardiogram incidentally found a right atrial mass. Clinical management was difficult due to the abrupt worsening of the patient’s clinical condition and the progressive severe thrombocytopenia. We suspected a thrombus, according to its echocardiographic appearance, the patient’s cancer history and recent venous thromboembolism. The patient was unable to adhere to low molecular weight heparin treatment. Due to worsening prognosis, palliative care was recommended. We also highlighted the distinguishing features between thrombi and tumors. We proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.
This case report highlights the importance of cardioncological surveillance during anticancer treatments to detect cardiac masses.
Core Tip: Cardiac masses are rare occurrences. In this case report, the diagnosis of a right atrial mass during cardioncological follow-up of a patient with secondary metastatic pancreatic cancer and a recent diagnosis of cancer-associated thrombosis was challenging. Severe thrombocytopenia and the rapid worsening of the patient’s condition hindered a complete clinical workup. However, echocardiographic differentiation between thrombi and tumors lead to the diagnosis of a new venous thromboembolism event. We also proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.