Right atrial mass: a diagnostic dilemma.

Dear Editor, The differential diagnoses of intracardiac masses include vegetation, thrombus or tumours. Size, shape, location, mobility and attachment of the mass combined with the clinical fi ndings help differentiate etiology. Echocardiography became the gold standard test for the diagnosis of intracardiac masses and later on transesophageal echocardiography (TEE) further improved the accuracy. Magnetic Resonance Imaging (MRI) can identify the amount of fat with a high degree of specifi city and can be used to diagnose cardiac lipomas.1 It is crucial to establish a correct diagnosis for proper management and therapy. We discuss a patient diagnosed with renal cell carcinoma (RCC) who presented with a right atrial mass identifi ed as a thrombus by TEE and lipoma by MRI. Because of the strong clinical suspicion for thrombus, she was maintained on anticoagulation and repeated TEE after 6 months showed resolution of the mass, confi rming the initial diagnosis of thrombus.