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Clin. Cardiol. 29, 512 (2006) : FIG. 1 Two-dimensional echocardiogram shows a large extrinsic mass compressing the left atrium. A 68-year-old man with history of quadruple-vessel bypass 15 years previously, presented with syncope and in cardiogenic shock. Two-dimensional echocardiogram revealed a large extrinsic mass compressing the left atrium (Fig. 1). Chest computed tomography confirmed the findings. In addition, the left pulmonary vein was also compromised. The patient expired during resuscitation.Autopsy revealed a ruptured bypass graft to the right coronary artery (Fig. 2), leading to hemopericardium with subsequent development of a localized tamponade compressing the left atrium and the left pulmonary vein.