Right Atrial and Endocardial Lead Mass Secondary to Anterior Mediastinal Mass Encasing Left Subclavian Vein.

INTRODUCTION: Multimodality cardiac imaging is a valuable tool for the noninvasive evaluation of right atrial masses (tumor, vegetation, or thrombus). CASE PRESENTATION: We report a case of right atrial mass that was discovered on a transthoracic echocardiogram ordered for pacemaker-pocket erythema in a 101-year-old man with heart failure/reduced left-ventricular ejection fraction and a dual-chamber pacemaker. Transthoracic and transesophageal echocardiogram showed a large hypoechoic mobile RA mass extending from the superior vena cava, with pacemaker device lead attachment. Infective endocarditis was excluded (no symptoms of systemic infection; negative blood cultures). CT angiography of the chest revealed an anterior mediastinal mass, highly suspicious for malignancy, encasing the left subclavian vein. The patient chose not to pursue invasive assessment of the mediastinal mass. Role of anticoagulation is unclear. CONCLUSION: Computed tomography complemented echocardiographic assessment and management of a right atrial mobile echo density due to a large anterior mediastinal mass.

Diffuse Alveolar Hemorrhage Secondary to Acute Mitral Regurgitation.

We describe acute mitral valve regurgitation in a young, previously healthy male patient presenting with diffuse alveolar hemorrhage. The patient initially presented with acute respiratory failure with refractory arterial hypoxemia despite mechanical ventilation. Bronchoscopy showed diffuse alveolar hemorrhage. The patient quickly developed cardiogenic shock, which required vasopressor infusion. Echocardiography showed severe mitral regurgitation and myxomatous mitral valve with anterior leaflet prolapse along with chordal rupture involving the anterior leaflet, which was flail. An Impella device was emergently placed, and the patient underwent mitral valve replacement with subsequent quick resolution of all symptoms.