Symptomatic atrial pacemaker lead thrombosis: detection by echocardiography and successful surgical treatment.

Formation of thrombi on a permanent pacemaker lead is a rare complication of pacing. However, because of its serious outcome it should be suspected in a patient who reveals right-sided heart failure, dyspnea, or syncope. An early decision to perform an echocardiographic examination, followed by surgical or thrombolytic treatment can solve this clinical problem. In a 69-year-old woman with increasing signs of congestive heart failure, echocardiography revealed a mobile mass in the right atrium attached to the pacemaker lead. Because of threatened symptoms and large dimensions of the mass, urgent surgical removal of the endocardial lead was successfully performed.

Right ventricular outflow tract obstruction by cardiac metastasis as the first manifestation of follicular thyroid carcinoma.

A 40-year-old man was sent to the echocardiographic laboratory because of a heart murmur. An intracardiac mass, causing obstruction of flow within right ventricle, was diagnosed and the patient was referred to surgery. Histologic examination classified the mass as a metastasis of highly differentiated follicular carcinoma of the thyroid gland. Thyroidectomy was performed and radioiodine treatment instituted. Thus echocardiographic identification of right ventricular outflow obstructing mass was the initial presentation of follicular carcinoma of the thyroid gland. Early detection of this moderately disseminated malignancy allowed for surgical excision and systemic radioactive iodine treatment.