Right atrium tumor thrombus

A 60-year-old man presented with 2 week history of nausea, vomiting, malaise and altered mental status. Vomiting was mainly postprandial, bilious with no blood. This was associated with decreased appetite and mild epigastric dull pain with no radiation. Review of systems was significant for shortness of breath, dyspnea on exertion with no chest pain or palpitations. He denied melena, hematochezia, change in bowel habits and stool characteristics, change in the color of the urine or change in weight. He had history of hypertension controlled with amlodipine. During examination he was arousable with disorientation to time and place. Vitals were stable. Abdomen was tender in the epigastric area with no rebound, shifting …