metastatic adenocarcinoma presenting as extensive cavoatrial tumor thrombus

the presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (ivc) or supradiaphragmatic carcinoma into the superior vena cava (svc). right atrial tumor thrombus with extension into both svc and ivc has not been reported in the literature. we present a patient who presented with symptoms of right atrial and svc obstruction. imaging revealed presence of a thrombus in the right atrium, extending to the svc and ivc, with the additional findings of a left adrenal mass and multiple liver lesions. the histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. the patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. the clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. this case highlights that in patients manifesting with extensive cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.