We present a patient with a right atrial mass, which was detected by transthoracic and transesophageal echocardiography. The patient was asymptomatic on presentation. The mass was subsequently confirmed by gross and microscopic examination to be a papillary fibroelastoma. To the best of our knowledge this is only the fourth such report of this tumor in this location.

A 36-year-old man presented 2 months back with complaints of dyspnea on exertion (class 3), cough, low-grade fever, anorexia, and weight loss. He was diagnosed as a case of pulmonary tuberculosis and was put on antitubercular therapy. However, he did not responded to therapy and discontinued treatment himself. Presently he was admitted with severe dyspnea, signs of right-sided heart failure, profuse sweating, and episode of transient blurring of vision. Initially transthoracic echocardiography was performed followed by transesophageal echocardiography (Figs. 1 and 2), which revealed a large heterogeneous sessile mass approximately 10 × 8 cm in right atrium, adherent to right atrial free wall, occupying most of right atrium extending into right ventricle and pericardial space, patent foramen ovale with left to right shunt and pulmonary hypertension. The echocardiographic findings explained the cause of signs of right-sided heart failure, which were due to mass effect, transient ischemic attack due to paradoxical embolization across patent foramen ovale, and pulmonary hypertension due to pulmonary embolism. Contrast-enhanced computed tomography of chest (Fig. 3) was performed, which also revealed same findings as transesophageal echocardiography. Right atrial angiosarcoma was the most probable diagnosis, which was further confirmed after biopsy. In our case transesophageal echocardiography turned out to be valuable and accurate modality in assessing cardiac mass, so timely assessment can help in early diagnosis and treatment. Figure 1. Transesophageal ultrasound demonstration at 0 degree. 1 = PFO (patent foramen ovale); 2 = large right atrial mass occupying right atrium; 3 = mass prolapsing through tricuspid valve orifice into right ventricle; 4 = infiltration of mass into pericardium. RA = right atrium; RV = right ventricle; LA = left atrium; LV = left ventricle; IAS = interatrial septum; IVS = interventricular septum; MV = mitral valve.