Incidental right atrial mass in a patient with secondary pancreatic cancer: A case report and review of literature

Table 1 Patient’s perspectives on her clinical history

Questions on patient’s perspectives	Patient’s answers
Patient’s own feelings	I feel very upset, anxious and sad. I already passed through cancer in the past and now I have to face it again. Why is this happening to me?
Patient’s sorrow for her family	My husband accompanies me to the hospital for visits and exams, but our life is devastated for the second time
Patient’s discomfort for treatments	I really don’t like these injections every day and I can’t pay someone to do it for me; therefore, my husband has to do it. During infusions I feel very weak
Patient’s complaints	I feel exhausted and for every effort I need my husband’s help, because of “missing air” sensation. I can’t breathe properly
Patient’s life insights	I hope the oncological treatments will help me. I should ask for psychological support. Now a second evil is in my lungs and all these complications are worsening my belief in life anymore

Table 2 Timeline of clinical history

Date	Event
2011	Breast cancer (right mastectomy and lymphadenectomy + adjuvant chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil + hormone therapy with tamoxifen)
2020	Pancreatic cancer with hepatic metastases (chemotherapy with nab-paclitaxel and gemcitabine)
February 2021	Second-line treatment with 5-fluorouracil, folic acid, oxaliplatin, irinotecan
May 2021	Deep vein thrombosis (right external iliac vein and both common femoral veins) and pulmonary embolism
	Start LMWH
June 2021	Persistence of deep vein thrombosis and pulmonary embolism
	LMWH replaced with edoxaban for inefficacy and patient’s preference
August 2021	Chemotherapy with carboplatin for worsening of liver metastases
September 2021	Dyspnea at rest and fatigue
	Echocardiogram: Incidental large right atrial mass, highly mobile and not vascularized, close to the ICV orifice
	Edoxaban replaced with LMWH due to thrombocytopenia and anemia
October 2021	Halved LMWH dose due to further platelet count decrease
November 2021	Marked decline of clinical general condition
	Discontinuation of anticancer drugs for severe disease progression
	Discontinuation of LMWH for severe thrombocytopenia
	Start palliative care

LMWH: Low molecular weight heparin; ICV: Inferior cava vein.

Table 3 Differential features between thrombus and tumor atrial masses by echocardiography

Thrombus	Tumor
Smaller size	Larger size
Single lesion	Single lesion (benign tumor)
	Multiple lesions (malignant tumor)
Mostly left atrium/left ventricle	Left atrium (benign tumor)
	Right atrium/multiple chambers/pulmonary artery trunk (malignant tumor)
Homogeneous tissue pattern, areas of lysis, “donut hole” appearance	Heterogeneous tissue pattern, irregular and patchy texture, areas of echolucency
Highly mobile and serpiginous	Not mobile
Broad based attachment	Attached by a stalk
Absence of intramass calcifications	Intramass calcifications, ossification, hemorrhage
Not infiltrating adjacent tissues	Intracardiac/extracardiac infiltration
Avascular	Vascularized
Poorly defined borders	Lobulated margins, definite edges
Absence of pericardial effusion	Associated pericardial effusion
Absence of metastases	Metastases may be present