Right atrial mass resembling ball valve thrombus in a patient with renal cell cancer

A middle-aged woman was admitted with progressive shortness of breath for 3 weeks. Clinical exam was unremarkable and further work-up was pursued. CT chest showed a cardiac mass and multiple opacities in the lungs (figure 1C). Echocardiogram demonstrated a 3×5 cm mass in the right atrium (online supplementary video 1) which was extending into the inferior vena cava (IVC) (figure 1A,B). These findings were highly suspicious for metastatic disease, but the primary was unknown. CT abdomen showed an 8.9×7.5×9.3 cm mass in the left kidney with …