The efficacy of echocardiography in the diagnosis of left heart tumors is well established. To date, however, only a small number of right atrial tumors (1 -5) and right ventricular tumors (6-7) have been described. Three cases are presented in which echocardiography detected a tumor in the right atrium. These cases emphasize the usefulness of this technique in the noninvasive examination of the right heart. Patient 1A 60 year old white female who had been found to have rheumatoid arthritis in 1968 presented in 1974 with rightsided stabbing pain in the lower anterior thorax and occasional sharp epigastric discomfort. These symptoms were associated with anorexia, intermittent sweating and fever,, weakness, easy fatigability, and mild shortness of breath. On examination a pericardial friction rub was heard. A diagnosis of pericarditis was made. The patient was treated with prednisone and isoniazid; however, these symptoms persisted for 1 2 months and the patient was eventually referred to this institution for further evaluation.Clinical examination on admission revealed typical cushingoid facies. Both wrists and hands displayed changes compatible with chronic rheumatoid arthritis. She demonstrated regular sinus rhythm and the jugular venous pressure was not raised. No murmurs were present. A pericardial friction rub was ausculted at the left sternal border. The heart was not enlarged.An echocardiogram was performed using a Unirad echograph and a 2.25 MHz focused transducer (13 mm diameter). A strip chart recording was obtained with a Tektronix recorder (B141619). The echocardiogram (Fig. 1) demonstrated multiple echoes behind the anterior tricuspid leaflet during ventricular diastole, compatible with the presence of a right atrial mass.Subsequent cardiac catheterization and injeccava (Fig. 2) demonstrated a large mass residing within the right atrium and prolapsing into the

There have been a number of reports of left atrial thrombus detection by echocardiography (1-4). However, a search of the literature failed t o reveal any reports of left ventricular throm bus diagnosed by this technique. A case is presented in which a ventricular thrombus was suspected by echocardiogram and was confirmed a t pathological examination of the specimen. CASE REPORTA 47 year old white male with a five-year history of hypertension and a three-year history of angina pectoris suffered an extensive inferinr wall myocardial infarction in August 1974. This event was complicated by extension of the infarction and severe congestive heart failure. He was maintained on digitalis and diuretics hut continued to have symptoms of mild congestive heart failure on this regimen. In December 1974, he experienced an embolus t o his right leg which responded to* medical therapy. In January 1975, he had further myocardial infarction again complicated by severe congestive heart failure.The patient underwent cardiac catheterization and at that time he demonstrated a mean pulmonary artery pressure of 35 mmHg and a left ventricular end diastolic pressure of 28 mmHg. Coronary angiography revealed total occlusion of the right coronary artery and subtotal occlusion of the left anterior descending coronary artery distal to the origin of the diagonal branch. which itself demonstrated high grade proximal stenosis. The circumflex coronary artery was also totally occluded. A left ventriculograni demonstrated focal areas of left-ventricular freewall dyskinesia and an extensive area of dyskin- esia of the diaphragmatic surface. There was a poorly defined opacity at the apex of the left ventric,le compatible with but not diagnostic of a thromhis. The patient was not considered a suitable (.andidate for revascularization surgery and was r<.lprred t o this institution for cardiac transplantation.Lcshocardiographic examination was perEvrnird using a commercially available echoc m l h 4 ' Tnirad) and a 2.25 MHz, 7.5 cm focused t r a~d i i~ 'r (13 mm diameter). Continuous ~m ('*-4 was obtained by means of a Tektronix striii ' ?rt recorder (B 191416). An echocardioera111 ( Fig. 1) was obtained from the fourth iritercostal space at the left sternal edge. On sc~jnniiig the left ventricular cavity, the anterior a n d posterior mitral leaflets were observed to be normal. The left ventricular maximal end diastolic dimension was 5.6 cm and the posterior wall of the left ventricle was markedly hypocont,ractile. On scanning toward the apex of the left vwtricle, the interventricular septum was seen to hwome hypoactive and thinned and a large inass of echoes appeared, closely applied t o the hypoactive, thin portion of the interventricular wptiini within the left ventricular cavity.Subsequently a donor heart became available. 'The patient's heart was removed at operation and subjected to pathological examination. Careful examination of the specimen revealed multip1p patchy areas of fibrosis particularly marked in the posterior wall of the left ventric...

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