Giant thrombus occupying the right cardiac chambers in a cancer patient: An unusual and incidental discovery

A 76-year-old woman with existing uninvestigated chronic hepatitis B presented with resting dyspnea and bilateral leg swelling. The patient was hemodynamically stable with a significant tricuspid murmur. Laboratory findings highlighted important hepatic cytolysis, moderate anemia, and increased D-dimers. Transthoracic echocardiography revealed a large, well-defined echogenic mass (30/80 mm) with hypoechoic central areas that occupied the right atrium (RA) almost entirely, protruded into the right ventricle (RV), and significantly obliterated the tricuspid valve (Fig. 1, Panel A, Supplementary Video S1). The mass also extended into the RV outflow tract with some smaller fragments protruding into the pulmonary artery (PA) (Fig. 1, Panel B). The subcostal view revealed that the mass seemed to originate from the inferior vena cava (IVC), which suggested a thrombus (Fig. 1, Panel C).