PMC5178349_01
Chest X-ray showing a rounding mass projecting over the right upper lobe and extending towards the right upper portion of cardiac silhouette.
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fig1
Routine chest X-ray evidenced a rounding mass projecting over the right upper lobe and extending towards the right upper portion of cardiac silhouette (Figure 1).
Chest CT showing a large opacity with irregular borders in the right upper lobe (a), with invasion of the right upper pulmonary vein (b-c) and extension into the left atrium (d). The arrows indicate the mass along its pathway from the right upper pulmonary lobe to the left atrium (LA). Note the lack of contrast signal in the right upper pulmonary vein, obstructed by the mass. AO, aorta; DA, descending aorta; LAA, left atrial appendage; LPA, left pulmonary artery; LIPV, left inferior pulmonary vein; LUPV, left upper pulmonary vein; LV, left ventricle; MPA, main pulmonary artery; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle; SVC, superior vena cava.
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fig2
Chest CT confirmed the presence of a large opacity with irregular borders, with invasion of the right upper pulmonary vein and extension into the left atrium (Figure 2).
((a) and (b)) Transthoracic echocardiography showing massive left atrial invasion by a large multilobed mass, with protrusion through the mitral valve into the left ventricle during diastole (arrow). ((c) and (d)) Transesophageal echocardiography confirming left atrial invasion by a large mass entering the left ventricle in diastole and showing regions of cystic colliquation within the mass (arrow). AO, aorta; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; RA, right atrium; RV, right ventricle.
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fig3
Transthoracic echocardiography showed massive LA invasion by a large, multilobed, highly mobile mass (48 x 35 mm) protruding through the mitral valve into the left ventricle during diastole (Figures 3(a) and 3(b)). Transesophageal echocardiography confirmed LA invasion with occlusion of the right upper pulmonary vein and pericardial infiltration through the LA roof, allowing visualization of areas of vascularization and some regions of cystic colliquation within the mass (Figures 3(c) and 3(d)).
Brain CT showing new multiple, diffuse hypodense lesions near the vertex in the left hemisphere (arrows).
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Brain CT showed new multiple, diffuse hypodense lesions near the vertex in the left hemisphere (Figure 4).
Chest magnetic resonance imaging showing invasion and subtotal obliteration of left atrial cavity from the right upper pulmonary vein (arrow). AO, aorta; DA, descending aorta; LA, left atrium; LPA, left pulmonary artery; LV, left ventricle; MPA, main pulmonary artery; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle; SVC, superior vena cava.
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fig5
On day 20, cardiac magnetic resonance showed a further increase in the dimension of LA mass with subtotal obliteration of LA cavity (Figure 5).