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Cardiac tumours are often an incidental finding; when they do cause symptoms, they can be systemic (pyrexia and fatigue), cardiac (arrhythmia, chest pain and obstructive) or embolic (stroke, pulmonary embolism (PE) and peripheral embolism). Different cardiac tumours have a higher prevalence in children when compared with adults, and each type of tumour has a predisposition for specific aspects of the heart. With current imaging modalities, it is possible to identify the location, haemodynamic impact and tissue characteristics of tumours, which can help diagnose the type of lesion and guide further management. This case is of an atypical appearance of a right ventricular mass, which was found incidentally following presentation with PE. The patient underwent successful surgical resection of the mass, which was identified as a myxoma. The patient is on imaging surveillance to monitor for recurrence. The case demonstrates the strengths and weaknesses of different imaging modalities, highlighting the importance of a multimodality approach to guide a diagnosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

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Primary cardiac tumours are very rare. Cardiac tumours in the perinatal period are even more uncommon with a prevalence of 0.0017% to 0.28% in autopsy series. The majority of benign cardiac tumours are cardiac rhabdomyomas, followed by cardiac fibromas. Another rare congenital heart disease is hypoplastic left heart syndrome (HLHS). Here we present a 21-week-old foetus diagnosed antenatally with HLHS on foetal echocardiogram. An autopsy done on the foetus following medical termination of pregnancy revealed a cardiac fibroma in the ventricular septum. It is very uncommon to have a combination of two congenital heart diseases. An extensive literature review revealed only three cases that had rhabdomyoma and associated HLHS. This case presented with cardiac fibroma which in early gestation would have resulted in left ventricular outflow obstruction leading to the development of HLHS. Small cardiac tumours which are difficult to detect by echocardiogram in early gestation can lead to the development of HLHS. A thorough and hierarchical autopsy examination of such cases can help in a better understanding of the relationship between HLHS and cardiac tumours., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

A patient in her early 20s presented with blood-stained sputum and shortness of breath. Initially, she was treated for pneumonia. Later, upon exacerbation of symptoms, further investigations were done which exhibited a left atrial mass causing compression of contralateral atrium. She underwent surgical resection of the mass, which was initially mistaken as myxoma. However, histopathological correlation revealed spindle cell sarcoma with focal myogenic differentiation. This case report highlights the role of Radiation Therapy in adjuvant setting with promising impact on improving local control after R2 resection. Cardiac spindle cell sarcoma, being one of the rarest cardiac tumours reported to date, warrants establishment of a Rare Tumour Multidisciplinary Team for management of such malignancies., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Cardiac myxomas (CM) are the most common type of primary cardiac tumours in adults, which have an approximate incidence of up to 0.2% in some autopsy series. The purpose of this review is to summarise the literature on CM, including clinical presentation, differential diagnosis, work-up including imaging modalities and histopathology, management, and prognosis. CM are benign neoplasms developed from multipotent mesenchyme and usually present as an undifferentiated atrial mass. They are typically pedunculated and attached at the fossa ovalis, on the left side of the atrial septum. Potentially life-threatening, the presence of CM calls for prompt diagnosis and surgical resection. Infrequently asymptomatic, patients with CM exhibit various manifestations, ranging from influenza-like symptoms, heart failure and stroke, to sudden death. Although non-specific, a classic triad for CM involves constitutional, embolic, and obstructive or cardiac symptoms. CM may be purposefully characterised or incidentally diagnosed on an echocardiogram, CT scan or cardiac MRI, all of which can help to differentiate CM from other differentials. Echocardiogram is the first-line imaging technique; however, it is fallible, potentially resulting in uncommonly situated CM being overlooked. The diagnosis of CM can often be established based on clinical, imaging and histopathology features. Definitive diagnosis requires macroscopic and histopathological assessment, including positivity for endothelial cell markers such as CD31 and CD34. Their prognosis is excellent when treated with prompt surgical resection, with postsurgical survival rates analogous to overall survival in the age-matched general population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

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The Carney complex (CNC) is a rare autosomal dominant genetic complex that is characterised by multiple neoplasms consisting of neuroendocrine and cardiac tumours, with only 750 cases reported worldwide as of 2017. Cardiac tumours, in the context of the CNC, are of unique importance since the leading causes of death in patients with CNC are cardiac. To prevent sudden cardiac death and embolic events, a difficult diagnosis must be made and postdiagnostic screenings must be regular. We present a case of a 52-year-old man, with a medical history of pituitary microadenoma and facial lentiginosis, who presented with dyspnoea 2 months after suffering a cerebrovascular accident., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Atrial myxoma is a benign primary heart tumour, which can be found incidentally on imaging studies. It is usually located in the left atrium and may manifest as dyspnoea, chest pain, heart failure, cough, shortness of breath when rising from a recumbent position, haemoptysis, hoarseness and as a source of cardiac embolism. However, dysphagia caused by an atrial myxoma has been reported only twice in the literature. We present a 53-year-old Caucasian man with a chronic history of dysphagia caused by an atrial myxoma, in which surgical resection resulted in complete resolution of his dysphagia., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

A previously well 48-year-old man presented with presyncope and was found to be in complete heart block. Blood tests, echocardiography and coronary angiography were reported as normal, and a dual chamber permanent pacemaker was inserted. Six months later he re-presented with breathlessness. His chest X-ray showed cardiomegaly and echocardiography revealed a 4.4 cm pericardial effusion. A CT thorax revealed a mass originating from the intra-atrial septum, extending into the right atrium and ventricle. There were multiple pulmonary lesions suspected to be metastases. Histology demonstrated high-grade B-cell lymphoma. He was treated with eight cycles of R-CHOP chemotherapy and showed good radiological and clinical improvement. Post-treatment echocardiography found severe left ventricular dysfunction with an ejection fraction of <20%. Heart failure medical therapy was optimised and the pacemaker was upgraded to a resynchronisation device. A repeat scan 6 months post device upgrade showed an improvement in ejection fraction to 45%-50%., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

While cardiac myxomas are the most common primary cardiac tumours, their overall incidence remains rare. Most cases (90%) are sporadic and occur in the third-sixth decades of life with a female predominance and have a specific predilection for the left atrium (75%). While often asymptomatic, clinical presentations depend on the tumour size, architecture and location. Echocardiography remains the mainstay for diagnostic evaluation. Tumour resection is the only definitive treatment. Histopathology using H&E and immunohistochemical stains, such as calretinin and CD34, confirms the diagnosis. We present a case of a patient with reported history of asthma who presented with recurrent acute on chronic shortness of breath refractory to inhaler therapy, multiple outpatient visits and hospitalisations for 'asthma exacerbations'. After further evaluation, she was diagnosed with a left atrial myxoma attached to the inferior aspect of the intra-atrial septum complicated by severe functional mitral stenosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

A 49-year-old man with a recent history of atrial tachycardia and intracardiac thrombus presented to the emergency department with melena and cardiac tamponade. Physical examination was notable for a vascular mass at the right lower gingival sulcus and a right chest wall nodule. Enteroscopy revealed a target lesion with friable ulcer in the gastric body. Cardiac MRI revealed a large right atrial mass, previously thought to represent thrombus. The patient was ultimately diagnosed with primary cardiac angiosarcoma (PCAS) by histopathology of gingival, gastric and subcutaneous lesions. This case illustrates the significant morbidity and mortality resulting from aggressive local invasion and growth of PCAS, as well as the challenge of differentiating between primary thrombosis and vascular malignancy. Misdiagnosis of this elusive clinical entity may be costly, potentially resulting in delay of intervention and adverse effects of alternate therapies such as anticoagulation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

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A 37-year-old man was presented in outpatient clinic of cardiology department with symptoms of easy fatigability and progressive increasing generalised anasarca since 5 months. Echocardiogram showed large mass of 9.8×7.8 cm in size in right atrium, attached to interatrial septum. Urgent opinion of thoracic surgeon was taken and surgical excision of mass under cardiopulmonary bypass was done. The tumour was large, fragile and histology confirmed it as myxoma. The patient made a good recovery and his symptoms resolved completely on follow-up., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Primary cardiac lymphoma (PCL) is a rare neoplasm involving the heart, pericardium or both. Patients with PCL have a median survival of approximately 7 months based on literature. We report a unique case of a 63-year-old woman presenting with worsening exertional dyspnoea and symptoms of superior vena cava obstruction. Investigations revealed a large right atrial (RA) tumour with obstructive features. In the past, PCL was frequently diagnosed at postmortem but with modern imaging and biopsy techniques, this allows early diagnosis and treatment of this rapidly fatal disease. Our patient had a trans-jugular venous biopsy of the RA mass under trans-oesophageal echocardiography guidance. This confirmed the diagnosis of PCL. She subsequently completed seven cycles of chemotherapy and is currently in remission 20 months after diagnosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Hepatocellular carcinoma (HCC) uncommonly metastasises to the heart. We present a case of new onset bilateral leg swelling and suspected right heart failure in a previously fit and healthy man, which on further investigation revealed a new diagnosis of HCC with extension into the inferior vena cava and right atrium. This case highlights the importance of considering alternative possibilities when physical examination does not match the initial clinical diagnosis. The management approach was for best supportive care in view of extensive metastatic disease., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

A 37-year-old man presented with acute chest pain, an unremarkable ECG and mildly elevated cardiac troponin. Coronary CT angiography showed a calcium score of 0 together with the absence of atherosclerotic plaques and normal origin and course of the coronary arteries. Transthoracic and transoesophageal echocardiography revealed an infracentimetric round-shaped mobile mass attached to a secondary tendinous chord of the anterior mitral valve leaflet. Cardiac magnetic resonance further evidenced localised contrast uptake supporting vascular irrigation, making thrombus unlikely. After surgical excision, the patient had an uneventful postoperative course. Histopathology disclosed the typical collagenous matrix covered by a single cell layer. Although mostly benign, cardiac tumours are prone to embolisation and can thus mimic an acute coronary syndrome. Multimodality imaging has an important role in unmasking the true mechanism, revealing less common aetiologies and elucidating the possibility of curative surgical resection., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Cardiac metastases from oral squamous cell carcinoma (SCC) are rare, especially in the absence of systemic metastasis. We describe a case of a patient presenting with chest pain and ECG abnormalities concerning for ST-elevation myocardial infarction that eventually was found to have an incidental right ventricular mass on chest CT angiogram. Ultimately, she had an intracardiac echocardiography-assisted biopsy diagnosis of isolated cardiac metastasis from primary oral SCC. The extent of the disease precluded any surgical intervention, and the patient subsequently transitioned to hospice care. Most cardiac metastases remain clinically silent until widespread systemic disease leads to death. Thus, cardiac metastasis should be considered in a patient with SCC who develops new cardiovascular symptoms or conduction abnormalities., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

We describe the case of a woman presenting with transient ischaemic attack, who was found to have a papillary fibroelastoma arising from the aortic wall, an extremely rare location. We describe the multimodality imaging techniques used in diagnosing this patient and review the most recent literature on evaluation and management of patients with cardiac papillary fibroelastomas., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

A 28-year-old pregnant woman presented at 28 weeks of gestation. She was diagnosed to have a left atrial myxoma 2 years earlier, but was lost to follow-up. During this pregnancy, the transthoracic echocardiography showed a 9 cm mass in the left atrium obstructing mitral valve inflow, interfering with mitral valve closure, causing severe mitral regurgitation and severe pulmonary hypertension. However, there were no clinical signs of pulmonary and systemic congestion or obstruction. Based on the clinical symptoms of the patient, the echocardiographic findings and the term of her pregnancy, the patient decided to schedule for a vaginal delivery with surgical correction after delivery. She gave birth at 32 weeks of gestation. During labour, pulmonary oedema developed but was detected early and it responded to therapy. Two weeks after delivery, a right anterior thoracotomy was performed to facilitate the removal of the left atrial myxoma and repair of the mitral valve., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Most benign primary cardiac tumours are myxomas; non-myxomatous tumours are less common but comprise a wide variety. Cardiac lipoma is a rare non-myxomatous variety. A 70-year-old Caucasian woman with right breast cancer status postpartial mastectomy underwent surveillance MRI of the breast and was found to have a possible right atrial (RA) mass. She also reported frequent headaches and palpitations. She underwent a transoesophageal echocardiogram which showed a 2.6×1.6×1.6 cm echogenic mass at the superior vena cava (SVC) and RA junction. She was anticoagulated for a possible thrombus without resolution. Surgical excision was undertaken in view of ongoing symptoms and partial occlusion of the SVC. Intraoperatively, a 2-3 cm smoothly textured lobulated mass was found and histopathology showed adipose tissue consistent with lipoma. The postoperative course was uneventful, and the patient was discharged in stable condition., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Primary cardiac sarcomas are rare malignant tumours and among them, leiomyosarcoma is extremely rare. They are especially rare in a young age group. We present a case of a 22-year-old male patient with primary leiomyosarcoma of the left atrium involving the pulmonary veins who presented with haemoptysis and shortness of breath. He underwent surgical excision of the tumour along with mitral valve replacement followed by adjuvant chemotherapy. No recurrence was reported on his second 6 monthly follow-ups., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Clinical Introduction: A 47-year-old female with no medical history presented with a sudden collapse. Physical examination, chest X-ray and high-sensitivity cardiac troponin I were normal, however ECG demonstrated anterior T-wave inversion. CT pulmonary angiography was performed which ruled out pulmonary embolism but revealed a non-calcified, homogenous mass at the left ventricular (LV) apex. It was not clear whether this mass was intramyocardial or pericardial. Transthoracic echocardiography confirmed the apical mass but was unable to establish its aetiology. Subsequent cardiac MR (CMR) demonstrated a highly vascular intramyocardial mass on perfusion imaging (Figure 1A, online supplementary video A), with striking, homogenous late gadolinium enhancement (Figure 1B) consistent with a diagnosis of cardiac fibroma.1 The patient underwent successful surgical excision of the mass (see online supplementary image A) and made a good symptomatic recovery, quickly mobilising around the ward. On examination, the patient was afebrile but had a blood pressure of 90/40 mm Hg and raised venous pressure. Postoperative imaging with echocardiography (see online supplementary video B) and CMR (Figure 1C, D and online supplementary video C) revealed some unexpected findings. Study the provided images., Question: What is the next most appropriate management step? Antibiotic therapy for pericardial abscessAnticoagulation for LV thrombusIntravenous fluids with close clinical and imaging follow-up of the intramyocardial haemorrhage and pericardial haematomaReturn to theatre for excision of residual tumourUrgent pericardiocentesis to drain pericardial collection., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

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An asymptomatic 18-year-old black woman was found to have an incidental finding of third-degree atrioventricular (AV) block on a routine ECG. 2-Dimensional transthoracic echocardiography showed a heterogeneous mass in the region of the peri-membranous septum in the AV node area. A cardiac MRI showed a well-defined cystic mass arising from the right side of the interatrial septal wall. An MRI compatible permanent pacemaker was implanted with plans to monitor the tumour with non-invasive imaging. Cystic tumour of the AV node is a rare primary cardiac tumour. It is known as the smallest and most common primary cardiac tumour that can cause sudden death. All previous six cases of living patients with cystic tumour of the AV node reported in the literature were females and symptomatic. We present a rare case of a patient with cystic tumour of the AV node, and we highlight the treatment dilemmas for this condition., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Clinical Introduction: A 66-year-old asymptomatic patient underwent a routine transthoracic echocardiogram prior to commencement of clozapine, and was found to have a mobile echogenic structure in the right atrium, which was later confirmed on transoesophageal echocardiogram to be adjacent to the insertion of inferior vena cava.Follow-up cardiovascular MRI (CMR) revealed a mobile, avascular 2.1×2.2 cm 2 mass with regular and smooth borders, adjacent to the eustachian valve (Figure 1 panel A: coronal view; online supplementary movie 1). Late gadolinium enhancement (LGE; panel B) demonstrated heterogeneity, and T1-imaging demonstrated mild hyperintensity (panel C). There was no evidence of obstructive haemodynamic compromise.The mass was subsequently resected, and the histology (H&E staining, magnification ×100) is shown in panel D., Question: The diagnosis of this mass is: Aberrant liverAngiosarcomaAtrial myxomaRenal cell carcinomaThrombus., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

A 68-year-old woman presented to the emergency department owing to exertional dyspnoea and bilateral leg oedema for 3 weeks. Her vital signs included the following: heart rate of 95 bpm, respiratory rate of 24 breaths/min, oxygen saturation of 73% on room air and a blood pressure of 184/108 mm Hg. Physical examination revealed tachypnoea with clear lungs to auscultation, elevated jugular veins, cyanosis and bilateral pitting oedema. A chest X-ray demonstrated cardiomegaly without obvious pulmonary oedema. A CT of the chest was negative for pulmonary embolus; however, the scan did reveal a large right ventricular (RV) mass. An echocardiogram with bubble study confirmed a patent foramen ovale with significant right-to-left shunting and a large RV mass that significantly obstructed the pulmonary outflow tract. A cardiac biopsy revealed a low-grade neuroendocrine tumour. The patient underwent successful debridement and adjuvant chemotherapy. She improved greatly and was asymptomatic at a 9-month follow-up visit., (2016 BMJ Publishing Group Ltd.)

Primary cardiac lymphoma (PCL) is rare, accounting for 2% of all primary cardiac malignancies. Diagnosis is sometimes slow due to the non-specific nature of symptoms, causing a delay to treatment with potentially curative anthracycline chemotherapy. We report an unusual presentation of primary cardiac lymphoma in an immunocompetent man presenting with subacute isolated right-sided heart failure with pericarditis on a background of chronic anaemia and constitutional upset. Echocardiography demonstrated a pericardial mass invading the right atrium and compressing the tricuspid annulus. Diffuse large B-cell lymphoma was diagnosed after biopsy. This case highlights the importance of early imaging and hospitalisation in pericarditis with high-risk features such as high inflammatory markers, myocardial involvement (with troponin elevation), fever, immunosuppression or evidence of heart failure. The differential and diagnostic pathway of an intracardiac mass, and the treatment and prognosis of PCL, are discussed., (2016 BMJ Publishing Group Ltd.)

This case report describes a patient in whom echocardiography showed borderline left ventricular hypertrophy and a mass adjacent to the right atrial wall. This naturally caused some concern as the differential diagnoses included that of a right atrial myxoma and further investigations were organised. A subsequent cardiac MRI revealed this thickening to be a prominent crista terminalis. The crista terminalis is a variant of normal anatomical structures within the right atrium, which mimics an atrial mass., (2016 BMJ Publishing Group Ltd.)

We report a case of a 40-year-old woman who presented with breathlessness, palpitations and vague pelvic pain for 6 months. The dyspnoea was non-exertional and episodic. She was a non-diabetic, non-hypertensive and had no history of prior surgeries. ECG and chest radiograph were normal. Cardiac MRI and 256-slice dual-source multidetector CT evaluation revealed the presence of a uterine and left adnexal mass with intravenous extension into the inferior vena cava via the gonadal veins, and further cephalad extension into the right atrium and ventricle. The patient was referred to the cardiothoracic surgery department and underwent two-stage surgical procedures. The first stage consisted of thoracotomy and tumour removal from the right atrium and inferior vena cava. In the second stage, hysterectomy and bilateral salpingo-oophorectomy was performed. The histological analysis of the excised specimen was consistent with an intravascular leiomyoma., (2015 BMJ Publishing Group Ltd.)

A 71-year-old man presented with shortness of breath and tachycardia along with systemic symptoms of weight loss and lethargy. A pulmonary embolus was the initial suspected diagnosis but through extensive investigations a rarer cause of his symptoms was identified. This case demonstrates the importance of cardiac imaging in the assessment and non-invasive tissue characterisation of a suspected cardiac tumour; in our case, this was subsequently confirmed by careful histological/immunocytochemical evaluation of the pericardial effusion as a primary cardiac B-cell non-Hodgkin's lymphoma, thus enabling appropriate management leading to an excellent clinical outcome., (2015 BMJ Publishing Group Ltd.)

We report a rare case of left atrial myxoma with concomitant classical Hodgkin's lymphoma in a 36-year-old woman with a non-significant medical history and 4 months of progressively worsening palpitations, dyspnoea on exertion, chest discomfort and fatigue. Outpatient echocardiography revealed functional mitral valve stenosis as a result of a large left atrial cardiac mass. Preoperative thoracic imaging revealed an anterior mediastinal mass with associated lymphadenopathy. The patient underwent successful resection of the anterior mediastinal mass and left atrial mass. Surgical pathology revealed myxoma in the left atrium and classical Hodgkin's lymphoma in the anterior mediastinum. Thus the patient was diagnosed with early-stage classical Hodgkin's lymphoma. This clinical vignette emphasises the importance of a comprehensive diagnostic evaluation in the setting of a newly discovered atrial tumour., (2015 BMJ Publishing Group Ltd.)

A 43-year-old man with an unremarkable medical history presented to our hospital with 2 weeks of headaches, ataxia and confusion. CT of the head revealed a large haemorrhagic cystic lesion. A subsequent chest CT revealed a large left atrial mass. The mass was subsequently biopsied with positive immunohistochemistry staining for MDM2, FLI1 and vimentin. Real-time PCR revealed MDM2 amplification, confirming the diagnosis of intimal sarcoma. The patient underwent surgical resection and reconstruction of the atrium with subsequent discharge to short-term rehabilitation, but his symptoms continued to progress. A repeat CT of the head revealed a new cerebellar mass. He underwent a second resection, but continued to experience worsening symptoms. He was diagnosed with stage IV intimal sarcoma and referred to hospice. The patient died 5 months after initial presentation. Autopsy was performed and revealed the cause of death as pneumonia. There was no involvement of the pulmonic or aortic vessels., (2015 BMJ Publishing Group Ltd.)

A 64-year-old previously healthy woman consulted her general practitioner because of recurrent episodes of right-sided monocular transient visual loss (ie, amaurosis fugax). At first, these symptoms were followed over time, but as the attacks worsened, and were accompanied by dizziness and general discomfort, the patient was admitted to the department of neurology for further investigations. CT of the brain was normal; however, during admission, the patient developed rapid atrial fibrillation and was transferred to the department of cardiology. Transthoracic echocardiography revealed a massive tumour on the atrial side of the anterior mitral valve leaflet, partly obstructing the mitral valve inflow. The tumour was excised and a biological prosthetic mitral valve inserted. The tumour was histologically determined to be a highly malignant dedifferentiated chondrosarcoma. After 6 months, the tumour relapsed and expanded aggressively to completely obstruct the mitral valve inflow, ultimately leading to cardiac arrest and death., (2015 BMJ Publishing Group Ltd.)

We present a case of isolated cardiac metastasis of oral squamous cell carcinoma. An 89-year-old woman was due to undergo curative resection of a histologically proven squamous cell carcinoma of the retromolar region. On admission, it was noted that there were ECG changes, and following further investigations, the patient was diagnosed with a cardiac metastasis of her oral malignancy. The presentation, including the diagnostic difficulties, as well as the clinical features of this rare case, are discussed., (2015 BMJ Publishing Group Ltd.)

A 62-year-old man presented to the cardiology clinic with symptoms of fatigue, shortness of breath and swelling in the abdomen and legs. A pedunculated mobile mass with a short stalk in the right atrium was found to originate from the inferior vena caval opening and prolapse into the right ventricle through a tricuspid valve during diastole in echocardiography. The patient was referred to our department and surgery was planned for right atrial myxomas diagnosis. The mass with surrounding tissue was surgically removed using the cardiopulmonary bypass method. No postoperative complications were seen in the currently asymptomatic patient who is still under our follow-up schedule., (2015 BMJ Publishing Group Ltd.)

Cardiac haemangiomas are extremely rare and account for approximately 2% of all primary resected cardiac tumours. They can occur in any chamber and at any level, from pericardium to endocardium. Myocardial contrast echocardiography is an imaging tool for the assessment of myocardial microcirculation. It can also be used for the evaluation of the relative perfusion of a cardiac mass. We report a case of a 17-year-old male patient who was referred for cardiological evaluation because of a 2/6 systolic murmur. Transthoracic echocardiography revealed a mass in the left ventricle. Using myocardial perfusion contrast echocardiography, the mass was rapidly filled with contrast greater than the adjacent myocardium, suggesting intense vascularisation. The mass was successfully resected and the subsequent histopathological examination showed a cardiac haemangioma. Therefore, myocardial perfusion contrast echocardiography appears to be a valuable diagnostic tool in differentiating the different types of cardiac masses., (2015 BMJ Publishing Group Ltd.)

Malignant lymphoma is known to cause various types of arrhythmia, including ventricular fibrillation. However, radiofrequency catheter ablation of ventricular fibrillation associated with malignant lymphoma has never been reported. We describe the case of a 53-year-old man with refractory ventricular fibrillation that was associated with malignant lymphoma. Electrophysiological testing revealed that a Purkinje potential appeared before ventricular contraction at the tumour site. We successfully treated the ventricular fibrillation with radiofrequency catheter ablation, using the Purkinje potential as an indicator. Physicians should consider this treatment if ventricular fibrillation cannot be controlled using other strategies., (2015 BMJ Publishing Group Ltd.)

A 37-year-old man presented with a history of episodic wheeze and breathlessness of 3 years' duration refractory to treatment. Physical examination revealed diffuse expiratory polyphonic rhonchi while the remainder of the examination including the cardiac examination was reported as normal. Pulmonary function testing revealed mild obstruction with bronchodilator reversibility. The patient was discharged on a 6-month course of antitubercular treatment (ATT) as bronchial brush cytology (obtained via bronchoscopy) was positive for acid-fast bacilli. The patient presented after completing 6 months of ATT with persistent symptoms, a loud S1 and a mid-diastolic murmur at the apex. High-resolution CT of the chest showed bilateral dependent ground glass opacities. An echocardiogram revealed a left atrial myxoma, and normal RV size and pressures. The patient underwent successful surgical removal of the same, and made a complete recovery. Refractory wheeze is a very unusual presentation of a left atrial myxoma., (2015 BMJ Publishing Group Ltd.)

Cardiac myxomas are a very uncommon cause of cerebral aneurysms. We present a case of a young woman with neurological symptoms attributed to small cortical infarctions and multiple cerebral aneurysms, caused by a cardiac myxoma., (2015 BMJ Publishing Group Ltd.)

A 67-year-old man was referred to our institution for the management of a left-sided intracardiac mass discovered following two cardioembolic events. Imaging studies revealed a highly mobile mass attached to the ventricular side of a calcified mitral annulus. The mass had not been present on echocardiography 1 year earlier. Surgical resection was performed. Microscopic examination confirmed the diagnosis of a calcified amorphous tumour. The postoperative course was unremarkable, and the patient remains asymptomatic and without recurrence of a mass or neurological event after a 12-month follow-up., (2015 BMJ Publishing Group Ltd.)

A 76-year-old immunocompetent woman presented to our hospital with general fatigue. Her blood pressure was 60/40 mm Hg and pulse rate was 110 bpm. An electrocardiogram showed ST-elevation in the II, III and aVF leads with complete atrioventricular block. An echocardiogram and CT revealed pericardial effusion and a 6 cm solid tumour lying anterior to the heart. The right coronary artery (RCA) ran through the centre of the tumour, which bulged into the right atrium for 35 mm and vibrated. Emergent coronary angiography revealed 99% stenosis with delay at the proximal RCA; however, intravascular ultrasound showed no atheromatous changes, and the RCA was compressed by the extravascular mass. Successful coronary stenting improved the coronary flow. The following day, a biopsy was performed via thoracotomy without any events, the results of which showed diffuse-type large B-cell lymphoma histologically. Chemotherapy gradually reduced the tumour size, and the patient became stable haemodynamically., (2014 BMJ Publishing Group Ltd.)

This is a case of a newborn male who was diagnosed in the first month of life with tuberous sclerosis following an incidental ultrasound finding of unilateral ventriculomegaly at 36+6 weeks gestation. The antenatal ultrasound scan at 36+6 weeks was performed to establish fetal lie. Subsequent fetal brain MRI showed lesions that were initially thought to be haemorrhages, but turned out to be features of tuberous sclerosis. The baby also had five cardiac rhabdomyomas and multiple ash leaf macules. This was an unusual presentation of tuberous sclerosis, which on average is diagnosed later (mean age of diagnosis is 5 years). It also illustrates two important points: that subependymal nodules and haemorrhage can have a similar radiological appearance on antenatal MRI and cranial ultrasound and that routine antenatal ultrasound screening will miss the majority of cardiac rhabdomyomas., (2014 BMJ Publishing Group Ltd.)

We report a case of a 51-year-old male patient with a known history of Carney complex, who was operated on for the fourth time due to recurrent left atrial myxomas. Despite surgical challenge, the operation was uneventful. The patient had a difficult postoperative period and needed further treatment for complications. After a prolonged recovery, he is currently well and remains myxoma-free up until now (36 months postsurgery) with regular follow-up using cardiac CT and transthoracic echocardiogram.

A 69-year-old man with a history of ischaemic heart disease and previous stent implantation in the right coronary artery (RCA) was found to have a large well-encapsulated mass attached to the right atrium on a routine transthoracic echocardiogram. Subsequent investigations including transoesophageal echocardiography and CT coronary angiogram suggested an RCA aneurysm formation in relation to the prior stented segment, further confirming on coronary angiogram a large ectatic vessel with a giant aneurysm measuring 2.4×2.7 cm. Giant coronary artery aneurysms are rare and here we present interesting images of a case initially picked up on transthoracic echocardiography.

We present a case of a 30-year-old woman with a history of HIV and hepatitis C who sought medical attention because of severe oedema of the lower limbs and abdomen. CT of the chest showed a thickened pericardium, and cardiac catheterisation demonstrated constrictive physiology. She underwent pericardiectomy, but the procedure was unsuccessful because the pericardium was densely adherent to the myocardium. After consultation with several pathologists, she was diagnosed with primary pericardial mesothelioma (PPM), an exceedingly rare cardiac tumour with a fatal prognosis. She died within 3 months of presentation. The details of the case as well as pertinent literature are reviewed.