a giant eustachian valve protruding into the right ventricle: a case report

introduction the eustachian valve (ev) remnant, when present in adults, is usually rudimentary. however, in echocardiographic examinations, it may appear as a mobile long structure in the right atrium, and it rarely protrudes into the right ventricle. when it is quite large, the ev remnant could be misdiagnosed as a right atrial tumor, thrombus, or vegetation. case presentation an 83-year-old patient was referred to the surgical ward for the excision of a gastric adenocarcinoma. in the course of preoperative assessment, transthoracic echocardiography showed a right atrial mobile filamentous mass that was protruding into the right ventricle. differential diagnosis included a tumor or thrombus. after a precise evaluation through multiple views, the mass was demonstrated to be a giant ev, 7.3 cm in length. conclusions the giant ev remnant can persist in adults and is often diagnosed incidentally via echocardiography. transthoracic echocardiography is a reliable noninvasive method for the diagnosis of the ev remnant and could help avoid its misdiagnosis as a tumor or thrombus. nevertheless, sometimes transesophageal echocardiography is necessary to confirm the diagnosis or to demonstrate the existence of an additive clot on it.