A 59-year-old asymptomatic man with systolic murmur and mediastinal mass.

A 59-year-old man came to medical attention due to a heart murmur noted approximately 10 years ago. He gave no history of a cardiac murmur as a child. The patient had been asymptomatic in this time period. More specifically, he denied dyspnea on exertion, chest pain, peripheral edema, palpitations, or syncope. The patient was a lifelong nonsmoker, and had no weight loss, fevers, or sweats. A surface echocardiogram done 3 years ago had shown a cyst-like structure adjacent to the left ventricle. Physical examination revealed a healthy man with normal first and second heart sounds and a grade 3/6 harsh systolic murmur heard best in the pulmonary area (second left interspace). There was no associated ejection click heard. No lymphadenopathy was noted. Chest radiography revealed a large left anterior mediastinal mass (Fig 1).