PMC6083489_01
Computed tomography chest with pulmonary embolism protocol. (a) Transverse view and (b) coronal view. In the transverse view, there is extensive involvement of the anterior portion of the cardiac tissue and that encases the right atrium, right ventricle, and the great vessels (*). There is evidence of filling defect in both the transverse and coronal views of the right atrium and ventricle, which suggests that the surrounding mass has infiltrated transmurally. The coronal view demonstrates how extensive the invasion is likely from an anterior to posterior approach. There is also extensive thickening of the transeptal and free wall.
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CT of the chest showed a large mediastinal mass with invasion of the pericardium (Figure 1); a soft-tissue mass within the right atrium; compression of the left atrial appendage; encapsulation of the thoracic aorta and pulmonary artery; and extensive mediastinal, hilar, and subcarinal lymphadenopathy:the largest of which measured 3 cm in diameter. CT of the abdomen and pelvis showed numerous intra-abdominal and retroperitoneal soft-tissue masses.
Transthoracic echo:parasternal long axis view. The cardiac cycle is in systole and the right ventricle fails to have concentric contraction demonstrated by the loss of curvature in the posterior right ventricle (*). This indicates severe right ventricle dysfunction with severe hypokinesis/akinesis in the basal to apical wall due to infiltration. The cardiac tissue overall lacks any significant involvement of the posterior walls given the normal left atrium and left ventricle.
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Transthoracic echo:parasternal short view. There is extensive homogenous echodense mass superiorly (S) and anteriorly (A) in relation to the cardiac tissue. The most striking feature is that despite the infiltration and surrounding of the cardiac structures of the right atrium, right ventricle, and the aortic valve, there is no evidence of tamponade physiology. The homogenous echodensity encases the ascending aorta at the level of the aortic valve (*), masking the coronary ostia leading into the coronary arteries.
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