Tumor-like formation of thrombus in the right atrial cavity is rare. It may be mistaken for a myxoma. The exact pathophysiology of an isolated thrombus in the heart is still unclear. Management to prevent complications such as pulmonary thromboembolism depends on the clinical judgment of a cardiologist. This report describes a 76-year-old woman with right atrial thrombus causing subsequent pulmonary thromboembolism in right lung. She initially presented to us with pulmonary embolism, and later, an incidental finding of a mass in her right atrium revealed an association of thrombus in heart with thrombus in lung. The challenging management was to resect this thrombus which was fixed to atrial septum, and a trial of anticoagulation did not resolve it. Exact management of such incidental findings in right heart cavities is not well established. Some cases may benefit from resection of such formed fixed thrombus.

Primary malignancies of the heart are so rare that most of the available data come from case reports or large single-center-based studies, with the overall incidence of 0.02% in the United States. Diagnosis in case of an isolated pericardial effusion as presentation is challenging, and determining that an angiosarcoma is even more challenging. Here, we presented a rare case of pericardial angiosarcoma which presented to us with tamponade. The patient eventually was diagnosed through pericardiectomy. A multimodality approach was attempted to treat the cancer. The clinical details of such a unique disease entity inspired us to present it as a case report.

Paragangliomas are rare tumors that arise from the sympathetic or the parasympathetic ganglia. Parasympathetic paragangliomas are usually nonfunctional. They are often found in the pre aortic and paravertebral sympathetic plexus or at the base of the skull. 80% of these are Glomus jugulare and carotid body paragangliomas. Intrapericardial paragangliomas are exceedingly rare. Less than 2% of paragangliomas are found in the chest and most of them are situated in the posterior mediastinum. As such, there are no clear guidelines on how to treat intrapericardial paragangliomas. We present here the case of a patient with an intrapericardial paraganglioma who was evaluated by cardiology, cardiac surgery, and endocrinology. In this case cardiac surgery opted for a conservative approach and did not offer surgery to the patient. There is some literature supporting a surgical approach but no specific guidelines about this have been written. The patient is currently being monitored since she did not have metastatic disease and her paraganglioma was nonfunctioning. With this case we want to add to the body of evidence that this type of cases does not need an urgent surgical approach.

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