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A 52-year-old woman presented with a nonproductive cough, mild dyspnea, and chest pain. The patient's medical history was significant for melanoma diagnosed in 1986. The melanoma was localized to the upper left side of her back and was treated with surgical resection. Otherwise, the patient's surgical history and medical history were unremarkable. Her family medical history was significant for lymphoma (mother) and colon cancer (sister). The patient smoked 1.5 packs of cigarettes a day for 20 years.The patient was afebrile and in no significant apparent distress at the time of presentation. She had no reported cervical or axillary lymphadenopathy at physical examination. Her oxygen saturation was 95% on room air. The laboratory values were normal except for iron deficiency anemia and a mildly elevated erythrocyte sedimentation rate of 36 mm/h (normal Ͻ30 mm/h). Imaging FindingsConventional chest radiography demonstrated a large anterior mediastinal mass projecting over the right hemithorax and right hilum. The mass measured approximately 12.5 ϫ 7.6 ϫ 6.6 cm. A right subpulmonic pleural effusion was also identified (Fig 1).Computed tomography (CT) of the chest, abdomen, and pelvis was then performed. Multiple spiral axial sections through the liver were obtained without intravenous administration of contrast material and during the hepatic arterial phase. Multiple spiral axial sections through the chest, abdomen, and pelvis were obtained during the portal venous phase. Oral contrast material was used.CT revealed a large mass in the anterior mediastinum to the right of midline, measuring 10.2 ϫ 4.6 cm in cross section (Fig 2a). The mass was heterogeneous in attenuation and contained areas of probable necrosis. The differential diagnosis for this mass included lymphoma, thymic carcinoma, and metastatic disease. CT also demonstrated a 0.8-cm mass in the left upper lobe and a 1.7 ϫ 1.0-cm nodule at the right lung base abutting the right hemidiaphragm (Fig 2b). These small nodules were suspicious for metastasis, although primary bronchogenic carcinoma could not be excluded. There was a small right pleural effusion and no left pleural effusion. Multiple small (Ͻ1 cm) lymph nodes were seen in the anterior mediastinum.A heterogeneous, low-attenuation mass was seen in the left atrium abutting the interatrial septum, measuring 5.1 ϫ 3.4 cm (Fig 2a). This mass was suspicious for a myxoma, although sarcoma or metastasis could not be excluded.The abdominal and pelvic organs appeared unremarkable with no retroperitoneal or pelvic lymphadenopathy. There was no ascites.Magnetic resonance (MR) imaging of the chest was performed by using electrocardiographically gated gradient-echo acquisitions. Fat-saturated double inversion-recovery and cine gradient-echo imaging was also performed. The large right mediastinal mass, the 1-cm nodular mass in the left upper lobe, and the 5.4 ϫ 2.8 ϫ 4.7-cm left atrial mass were again evident. The mediastinal mass appeared to be focally invading the anterior chest wall (Fig 3). These three masses al...

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