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JAMA Cardiology Clinical Challenge
October 14, 2020

A Mobile Intracardiac Mass in a Middle-aged Woman

Author Affiliations
  • 1Department of Cardiovascular Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
JAMA Cardiol. Published online October 14, 2020. doi:10.1001/jamacardio.2020.4865

A woman in her mid-40s presented for evaluation of chronic abdominal distension and dyspepsia. The patient had a history of uterine fibroids and a right-sided ovarian cyst for 5 years, but she denied symptoms, including abdominal pain, abnormal defecation, abnormal vaginal bleeding, fever, or weight loss. She had no history of intravenous drug use. A physical examination was notable for jugular venous pulsations and a grade 3/6 systolic murmur best heard at the fifth intercostal space in the left side of the sternum. Laboratory studies revealed normal serum chemistry levels. A complete blood cell count showed a hemoglobin level of 12.7 g/dL (reference, 11.3-15.1 g/dL [to convert to grams per liter, multiply by 10]), a white blood cell count of 7400 cells/μL (reference, 4000-10 000 cells/μL [to convert to cells ×109 per liter, multiply by 0.001]), and a platelet count of 42 × 103 cells/μL (reference, 100 × 103 to 300 × 103 cells/μL [to convert to cells ×109 per liter, multiply by 1.0]). The prothrombin time was 16.5 seconds (reference, 10-14 seconds); activated partial thromboplastin time, 47.5 seconds (reference, 23-35 seconds); fibrinogen level, 52 mg/dL (reference, 185-350 mg/dL [to convert to grams per liter, multiply by 0.01]); and D-dimer, 5190 μg/mL (reference, <590 μg/mL [to convert to nanomoles per liter, multiply by 5.476]). Abdominal ultrasonography showed no abnormalities, but a transthoracic echocardiogram showed a mobile mass located on the tricuspid valve associated with moderate tricuspid regurgitation (Figure 1; Video).