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Rong Liu,1,* Tingfen Ji,1,2,* Yixia Jiang,1 Hequan Li1 1Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Lishui People’s Hospital, Lishui, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hequan Li, Email lihequan@zju.edu.cnPurpose: Recurrent inflammatory fevers with multisystem involvement occur clinically and may indicate an autoimmune disease.Case: We present a young male diagnosed with pulmonary embolism who experienced recurrent fever during hospitalization and was unresponsive to antibiotics and antipyretics. A follow-up history revealed chronic oral and genital ulcers, leading to a final diagnosis of Behçet’s disease.Conclusion: The patient’s temperature normalized rapidly after corticosteroid therapy, and infection markers returned to normal. Complete remission was achieved with immunosuppression and glucocorticoid therapy. Reporting characteristics, treatment experience, and outcomes of such cases are essential to inform future diagnosis and management strategies.Keywords: fever, Behçet’s disease, pulmonary embolism, atrial mass

Advanced hepatocellular carcinoma (HCC) with metastasis is linked to a bleak diagnostic prognosis. Common sites of dissemination involve the lungs, portal vein, and portal lymph nodes. This report presents a rare case of a 57-year-old man with a right atrial mass, a thrombus of an undiagnosed multifocal HCC. This case demonstrates the crucial role that transoesophageal echocardiography (TEE) has in promptly confirming the diagnosis with more details, as well as monitoring the surgery. The transthoracic and, in particular, the TEE were valuable in this patient's case in providing a timely resolution of an urgent right atrial mass/HCC thrombosis. [ABSTRACT FROM AUTHOR]

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Key Clinical Message: The key takeaway from this clinical scenario is to choose the most appropriate and reasonable treatment plan when dealing with a patient who has atrial septal defect (ASD) and concurrent atrial and mediastinal masses. In such cases, a heart‐oncology team should make the therapeutic decision. Right atrial masses are not pretty rare and might be a diagnostic challenge. Thrombosis, tumors, and vegetations are primary differential diagnoses. Workup for these masses usually includes multimodality imaging and biopsy in selected cases. We report a case of a 37‐year‐old lady who presented with cough, dyspnea, and head and neck swelling after a cesarean section. Echocardiography revealed a right atrial mass accompanied by a secundum type atrial septal defect (ASD). Pulmonary CT Angiography was performed, in which a lobulated mass in the anterior mediastinum was detected, and a heart‐oncology team made the therapeutic decision. The patient was scheduled for surgical ASD closure and concomitant tissue biopsy. The pathology results were in favor of poorly differentiated germ cell tumors, and chemotherapy was started following the surgery. After two sessions of chemotherapy, the tumor did not respond to the primary regimen. Thus, an updated regimen was initiated. Compliance with the updated regimen was acceptable, and the patient is currently under treatment and follow‐up. [ABSTRACT FROM AUTHOR]

Merga Daba Mulisa,1 Shalom Kassahun Bekele,1 Sisay Bekele Woldemichael,2 Sitota Ganjula Gaito,3 Fadil Nuredin Abrar,4 Betelhem Gebreamlak Hailu4 1Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Cardiothoracic Unit, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia; 3Cardiology Unit, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia; 4Department of Pathology, School of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Merga Daba Mulisa, Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251912684411, Email mergadaba1995@gmail.comAbstract: Left atrial masses are commonly caused by atrial myxomas and metastatic tumors. Primary cardiac sarcomas are rare. Patients present with symptoms related to the tumor location. There are only a few case reports on this rare disease. We report the case of a 17 years old male patient presented with shortness of breath for 2-month duration. Echocardiography revealed a left atrial mass that was later surgically excised and histopathology confirmed a primary cardiac sarcoma. We discuss the diagnostic and therapeutic challenges encountered in the management of this rare disease. To the best of our knowledge, this is the first case reported in East Africa.Keywords: primary cardiac sarcoma, atrial mass, atrial myxoma

A 54‑year‑old patient with a medical history of hypertension, dyslipidemia, and diabetes underwent mitral valve replacement surgery with a biologic valve. During a chest computed tomography scan for breast neoplasia staging, a reduced luminal filling in the left atrium (3.6 cm) was unexpectedly found, prompting further cardiac evaluation. The patient was referred to the emergency department experiencing shortness of breath and fatigue, which improved after furosemide administration, and remaining stable throughout hospitalization. Atransesophageal echocardiogram was performed the following day and revealed a biologic mitral valve prosthesis slightly displaced toward the left ventricle with an average transprosthetic gradient of 7 mmHg. Notably, a sizable intermediate echogenic mass measuring 3.0 cm × 3.5 cm was detected and attached to the prosthesis ring in a lateral and posterior position, within the left atrium. A mild degree of periprosthetic regurgitation was also noted. Given the substantial suspicion that the observed mass was a thrombus, the patient was commenced on anticoagulation therapy while awaiting cardiac magnetic resonance imaging for better characterization of the mass. Over 4 weeks, the thrombus notably decreased in size, disappearing entirely by the 6th week. This case highlights the significance of employing multiple imaging techniques in managing cardiac masses. The incidental discovery of the mass, its characterization, and subsequent management through anticoagulation, followed by confirmation and monitoring through echocardiogram, underscore the importance of a multimodal approach in diagnosing and treating such conditions. [ABSTRACT FROM AUTHOR]

Introduction: cardiac myxomas are the most common primary neoplasms of the heart. The most common location is the left atrium (75%), followed by the right atrium (15- 18%) and left ventricle. They may present with the triad of obstructive, embolic and constitutional symptoms. Case 1: a 59-year-old man under follow up for non-Hodgkin cutaneous T cell lymphoma, suffering from progressive dyspnea, was found to have a mass located on the right atrium. Resection of the tumor was performed, and replacement of the mitral valve due to severe mitral regurgitation. Histopathology confirmed the diagnosis of myxoma. Case 2: a 61-year-old woman presented with thrombosis in the basilic, cephalic and right jugular veins. An echocardiogram showed an 80 × 40 mm cardiac mass in the right atrium. On the histopathological report, a cardiac myxoma with the greatest diameter of 7.5 cm was reported. The patient was discharged nine days after surgery. Conclusion: there could be an unusual presentation of atrial myxoma occurring simultaneously with a neoplasm of different lineage. Atrial myxoma should be suspected even in unusual locations and regardless of concomitant neoplastic disease. Embolic phenomena, as the first presentation, may be misleading, although some parameters and scores might be useful predictors. [ABSTRACT FROM AUTHOR]

Although the differential diagnosis for cardiac masses is broad and includes both benign and malignant primary cardiac tumors, metastases of noncardiac primary malignancies to the heart are an important etiology. We present an unusual case of a rapidly progressive right atrial mass caused by metastatic hepatocellular carcinoma., Competing Interests: Dr Carrick is funded by the National Institutes of Health (T32HL007227, L30HL165535) and is a recipient of the Semyon and Janna Friedman Fellowship award. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Cardiac involvement in multiple myeloma is rare. We report a rapidly progressive atrial mass and plasma cell–infiltrated pericardial effusion with tamponade. Bone marrow biopsy and plasma immunoelectrophoresis confirmed multiple myeloma (Revised International Staging System Stage III). The patient died within 18 weeks of presentation, suggesting aggressive disease with poor prognosis. (Level of Difficulty: Beginner.)

Abstract Lipomatous hypertrophy of the interatrial septum can have an atypical appearance by transthoracic echocardiography. The authors emphasize on the importance of the multimodality imaging approach to reach the appropriate diagnosis in such cases.

In this rare case of intrahepatic cholangiocarcinoma (ICC) tumor thrombus with right atrial (RA) invasion, we describe its diagnostic workup based on cardiac magnetic resonance imaging (cMRI). An 85‐year‐old man underwent transthoracic echocardiography due to dyspnea, revealing a RA mass. Comprehensive cMRI evaluation, including cine bright blood, T1‐ and T2‐weighed, fat‐suppressed, and contrast‐enhanced imaging, was performed and diagnosis of ICC tumor thrombus with RA invasion was made. This first description of cMRI‐guided diagnosis of RA invasion by ICC tumor thrombus points out the usefulness of cMRI for the diagnostic approach of RA masses suggestive of tumor thrombus. [ABSTRACT FROM AUTHOR]

Lipomatous hypertrophy of the interatrial septum can have an atypical appearance by transthoracic echocardiography. The authors emphasize on the importance of the multimodality imaging approach to reach the appropriate diagnosis in such cases. [ABSTRACT FROM AUTHOR]

Background  Atrial myxomas are the most common benign cardiac tumours. This case highlights an unusual presentation and complex management of a patient who was incidentally found to have a left atrial tumour concerning for a myxoma. Case summary  A 54-year-old-woman presented with symptoms of nausea and vomiting and was found to have a left atrial mass incidentally in addition to a renal infarct. She was also found to have COVID-19 and the mass was initially thought to be a thrombus. With the help of multimodality imaging, it was determined that the mass was an atrial myxoma and she was started on short-term anticoagulation to prevent recurrent embolization. After 6 weeks of anticoagulation, she successfully underwent elective resection of the mass which was confirmed to be myxoma with superimposed thrombus. Discussion  It is difficult to differentiate cardiac tumours from intracardiac thrombus and multimodality cardiac imaging is crucial to make an accurate diagnosis. While the treatment of atrial myxomas involves early surgical resection, it becomes more complicated with concurrent COVID-19 infection. [ABSTRACT FROM AUTHOR]

Ebstein’s anomaly is a rare entity affecting around 1 in 200,000 live births and accounts for less than 1% of congenital heart diseases. Ebstein’s anomaly with an associated right-sided myxoma is extremely rare, with only one other case report found in the literature. Previous reports have also noted cases of Ebstein’s anomaly associated with left-sided myxomas. We describe a female patient with, to our knowledge, the first case of a histopathologically confirmed right ventricular myxoma in the setting of Ebstein’s anomaly.

Primary pulmonary mucosa-associated lymphoid tissue（MALT） lymphoma is a very rare disease. Chest radiographs or computed tomography may confuse MALT with other pulmonary diseases， resulting in misdiagnosis or delayed treatment，this can lead to misdiagnosis or delayed treatment. In this case，the patient was delayed by more than five years because it was difficult to diagnose.The patient visited the doctor due to chest pain and found a large amount of pleural effusion on the right side.Anti-tuberculosis treatment was given at that time，but the pulmonary lesion was still progressing slowly.Meanwhile，the left lung lesion was also present，and lymph nodes in the mediastinum were fused，and later the lesion involved the heart，presenting pericardial effusion. The patient went to Zhongshan Hospital for treatment，and underwent bronchial，lymph node and atrial tumor puncture examination by ultrasonic bronchoscopy.It was confirmed as pulmonary MALT lymphoma in the pathological and immune groups. [ABSTRACT FROM AUTHOR]

• Thrombus associated with catheters can cause untoward outcomes. • Indwelling catheters must be cared for and undergo timely removal. • Open heart surgery may be required to remove a mass inside the heart caused by these catheters. Intracardiac masses pose a difficult diagnostic and therapeutic dilemma. Indwelling catheters can lead to thrombus calcification causing untoward sequelae. We report on a patient who presented after computed tomography identified a large calcified right atrial mass. Her history included treatment for rectal cancer and breast cancer, thus we feared the mass could represent metastasis. The intracardiac mass was successfully resected via a right atriotomy. Her postoperative course was uneventful and the histopathology revealed a calcified thrombus. In this report we discuss our findings and pre- and intraoperative considerations, as well as suggestions for management of implantable venous catheters. This is a rare complication of an indwelling catheter. Operative management of intracardiac lesions is the standard of care. When related to implantable catheters, the best patient care would be prevention of such lesions. This would include routine flushing of the indwelling catheters and prompt removal once not in use. [ABSTRACT FROM AUTHOR]

Dedifferentiated liposarcoma (DDLPS) is a rare type of neoplasm which can originally rise in cardiac chamber. Owing to the recurrence and distant metastasis, the prognosis of the primary malignant cardiac tumor is extremely poor and remains a challenge for cardiac surgeons. Here, we report a patient with an intracavitary mass which was diagnosed as DDLPS by postoperative pathological examinations, experienced repeated in-situ recurrence of the malignant cardiac tumor. [ABSTRACT FROM AUTHOR]

A 54-year-old patient with a medical history of hypertension, dyslipidemia, and diabetes underwent mitral valve replacement surgery with a biologic valve. During a chest computed tomography scan for breast neoplasia staging, a reduced luminal filling in the left atrium (3.6 cm) was unexpectedly found, prompting further cardiac evaluation. The patient was referred to the emergency department experiencing shortness of breath and fatigue, which improved after furosemide administration, and remaining stable throughout hospitalization. A transesophageal echocardiogram was performed the following day and revealed a biologic mitral valve prosthesis slightly displaced toward the left ventricle with an average transprosthetic gradient of 7 mmHg. Notably, a sizable intermediate echogenic mass measuring 3.0 cm × 3.5 cm was detected and attached to the prosthesis ring in a lateral and posterior position, within the left atrium. A mild degree of periprosthetic regurgitation was also noted. Given the substantial suspicion that the observed mass was a thrombus, the patient was commenced on anticoagulation therapy while awaiting cardiac magnetic resonance imaging for better characterization of the mass. Over 4 weeks, the thrombus notably decreased in size, disappearing entirely by the 6 th week. This case highlights the significance of employing multiple imaging techniques in managing cardiac masses. The incidental discovery of the mass, its characterization, and subsequent management through anticoagulation, followed by confirmation and monitoring through echocardiogram, underscore the importance of a multimodal approach in diagnosing and treating such conditions., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Cardiovascular Echography.)

Abstract We present a 36-year-old man who presented to our emergency department with acute onset shortness of breath and syncope. He was found to have a large left atrial mass on initial computed tomography (CT) which was confirmed by echocardiography. Tumor biopsy and attempted excision were performed, showing a primary cardiac spindle cell sarcoma that was unable to be resected, to which the patient eventually succumbed to. Spindle cell sarcomas of the heart are very rare primary cardiac tumors, with a variable, non-specific presentation. The most effective treatment is surgical resection, with chemotherapy and radiotherapy showing some benefit. Despite these treatments, the prognosis is poor. Given the uncommon nature of this tumor, the objective of this report is to demonstrate the clinical presentation and CT imaging characteristics of a case of primary cardiac spindle cell sarcoma, to raise awareness of this entity, and to increase the index of suspicion as a potential differential diagnosis to cardiac tumors seen on imaging. Highlights • Left atrial spindle cell (intimal) sarcomas are rare primary cardiac tumors. • To our knowledge, this is only the seventh case published of this tumor. • Prompt imaging and tissue diagnosis is crucial to expedite an aggressive treatment approach. • The tumors display many of the typical malignant cardiac tumor findings on imaging. • Prognosis is very poor due to recurrence and early metastasis. [ABSTRACT FROM AUTHOR]

A 73-year-old man presented with lower back pain and bilateral palmar lesions. Urine culture grew Streptococcus agalactiae and C-reactive protein was raised. He was treated with antibiotics for urinary tract infection with suspected pyelonephritis. An echocardiogram ordered to look for infective endocarditis was suggestive of a left atrial myxoma. He subsequently developed an acute right common iliac artery embolus, which resolved with conservative management. He underwent a successful open-heart left atrial mass and appendage resection, with histopathology confirming atrial myxoma. Skin biopsies of the lesions ten weeks post onset showed granuloma annulare of the palms. [ABSTRACT FROM AUTHOR]

Primary cardiac leiomyosarcoma has an extremely low incidence with overall median survival of approximately 6 months. Here, We report the case of a 60-year-old man who underwent complete surgical excision of right atrial mass. Histologic examination revealed leiomyosarcoma. The patient made a full recovery with no evidence of recurrence at 24 months. To the best of our knowledge, this is the first reported case or primary cardiac leiomyosarcoma in the Middle East. [ABSTRACT FROM AUTHOR]

An unusual cause of pulmonary emboli from an evanescent right atrial mass is described in this case report. The systematic approach from initial presentation to a definite diagnosis of a rare condition is described.

The heart is a destination for metastases of various types of primary tumors, with lung, breast, melanoma, and mesothelioma being the most common types. Recurrent isolated cardiac metastasis presenting as a cavitary mass is rare. We present a case of recurrent isolated cavitary metastatic mass to the right atrium in a patient with the history of breast cancer who presented with new‐onset atrial fibrillation. The patient successfully received radiation therapy with the resolution of the mass confirmed on repeat echocardiography. [ABSTRACT FROM AUTHOR]

Cardiac hemangioma is very rare and accounts for 2%–3% of the primary cardiac tumors. Cardiac epitheloid‐capillary hemangioma has not been reported in the pediatric population so far. We report the fatal outcome of a preterm neonate with a huge congenital right atrial epitheloid‐capillary hemangioma and elevated serum alpha‐fetoprotein, associated with prolonged QT interval. We describe the echocardiographic, computed tomographic (CT) imaging, microscopic and immunohistochemical features of the tumor. Complete resection of the tumor was done at operation necessitating extensive reconstruction of atrial walls. Intramural infiltration of this tumor into the surrounding myocardial walls is a challenging characteristic of cardiac hemangioma. The temptation to complete resection should be avoided in the setting of extensive intramural infiltration and entrapment of the tumoral cells into atrial walls, particularly in a preterm neonate. None of the current classifications for hemangioma was inclusive of our case. Based on a concise literature review of nine published classification systems from 1996 to 2017 , we discuss the shortcomings of the current classifications for hemangioma. We also performed a 25‐year‐review of 299 cases of primary cardiac tumors in neonates and children, from 1993 to May 2018. We suggest a stepwise surgical treatment strategy according to the characteristics of the patient and of the tumor, based on this review. The stepwise strategy includes watchful observation, partial resection, complete resection and cardiac transplantation. [ABSTRACT FROM AUTHOR]

Cardiac tumors are exceedingly rare (0.001–0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.

We report a case of an asymptomatic patient in whom a right atrial mass was fortuitously documented by echocardiography few months after a transcatheter radiofrequency catheter ablation for recurrent AF. No masses were seen in the cardiac chambers before the ablative procedure, raising important diagnostic and decision-making issues. The patient was referred to the surgeon and a diagnosis of right atrial myxoma was made.

It is rare that a left atrial appendage thrombus will grow to the extent that it can prolapse into the left ventricle. We report the case of a large prolapsing left atrial thrombus diagnosed by 3D echocardiography in a patient presenting with a transient ischemic attack. [ABSTRACT FROM AUTHOR]

Background: 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., Case Summary: 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., Conclusion: This case report highlights the importance of cardioncological surveillance during anticancer treatments to detect cardiac masses., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

The authors describe the case of a child with a history of relapsed acute lymphoblastic leukaemia with a giant intra-auricular lymphomatous mass, submitted to investigation by multiple imaging methods and biopsy.

Eustachian valve ( EV) is a vestige of the valve of the inferior vena cava which directs the umbilical vein blood through open foramen ovale in fetal life. Following birth it gradually regresses, but it may persist in variable size, shape, and thickness as a functionless and benign structure. However, there are reports suggesting that persistent EV may not be completely innocent. It has been accused of being a predisposing cause of patent foramen ovale and paradoxical embolism and also interfering with transseptal interventional procedures. It may serve as a site of infective vegetations and be mistaken as a tumor or thrombus. In the present case, an octopus-like thrombus attached to the EV was delineated with the utility of two-dimensional and real time three-dimensional transesophageal echocardiography. EV was considered to play an essential role in preventing potential pulmonary embolism. [ABSTRACT FROM AUTHOR]

A73-year-old man with past medical history of mechanical aortic valve replacement, metastatic melanoma of unknown primaries with liver metastasis, presented with progressive shortness of breath and dyspnea on exertion. Transthoracic echocardiography (TTE) showed a large homogenous mass completely occupying the right atrial cavity and extending to and nearly obstructing the inflow area of the tricuspid valve. He was treated with chemotherapy.

Abstract: Background: Although a large isolated surface area of the left atrium (LA) may improve the success rate of catheter ablation (CA) for paroxysmal atrial fibrillation (AF), little is known about the relation between clinical outcomes and the amount of atrial mass reduction (AMR: ratio of total isolated and ablated areas to LA surface area) in different ablation strategies for patients with long-standing persistent AF (L-PeAF). Methods: We randomly assigned 119 consecutive L-PeAF patients to adjunctive linear ablation (n =60) or complex fractionated atrial electrogram (CFAE)-guided ablation (n =59) after circumferential antral pulmonary vein isolation (PVI). Linear lesions included roof and anterior lines with conduction block. LA defragmentation was performed with an automated CFAE-detection algorithm. Cavotricuspid isthmus block was performed in all patients. Creatine kinase-MB (CK-MB) and troponin-T levels were measured 1day post-CA. Results: CK-MB and troponin-T levels were higher, ablation time was longer, and AMR was greater in the CFAE-guided ablation group than in the linear ablation group. AF termination during CA was more frequently observed in the linear ablation group than in the CFAE-guided ablation group (P =0.031). Twelve months after a single procedure, recurrence occurred in 16 (26.7%) patients with linear ablation and 27 (45.8%) patients with CFAE-guided ablation (P =0.023). On multivariate analysis, LA volume and ablation method were the only independent risk factors for arrhythmia recurrence. Conclusion: Conduction block through linear lines+PVI was an efficient ablation strategy for L-PeAF, whereas the AMR amount did not influence clinical outcomes. [Copyright &y& Elsevier]

Aneurysms of the coronary arteries are rare and are usually associated with atherosclerosis in adults. Mycotic coronary artery aneurysms are exceedingly uncommon and are typically associated with systemic bacteremia, endocarditis, or septic emboli. Literature and data describing the management of mycotic coronary artery aneurysms are limited. This case describes the successful diagnosis of a large right coronary artery aneurysm by transesophageal echocardiogram as well as the successful management of the aneurysm. [ABSTRACT FROM AUTHOR]

Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children. Extramedullary leukemia including hepatosplenomegaly, lymphadenopathy, and mediastinal mass are the clinical presentations of T-cell ALL. Pericardial effusion and atrial mass are rare presentations of pediatric leukemia. Case Presentation: We report a 15-year-old girl with T-cell ALL, who presented initially with pericardial effusion and cardiac tamponade and subsequently developed right atrial mass. The mediastinal and right atrial masses were excised by surgical procedure as a treatment strategy for prevention of arrhythmia and sudden death. Conclusion: T-cell ALL can present with pericardial and mediastinal involvement as an initial manifestation. Pericardiocenthesis and systemic anticancer chemotherapy without local chemotherapy should be considered in these cases. [ABSTRACT FROM AUTHOR]

Training in echocardiography is essential for an intensivist. We present a rapidly fatal case of obstructive shock where a vigilant intensivist could diagnose left atrial mass obstructing the mitral inflow as the etiology of shock. [ABSTRACT FROM AUTHOR]