title: Metastatic Adenocarcinoma Presenting as Extensive Cavoatrial Tumor Thrombus.
abstract: The presence of tumor thrombus in the right atrium is frequently the result of direct intraluminal extension of infra-diaphragmatic malignancy into the inferior vena cava (IVC) or supradiaphragmatic carcinoma into the superior vena cava (SVC). Right atrial tumor thrombus with extension into both SVC and IVC has not been reported in the literature. We present a patient who presented with symptoms of right atrial and SVC obstruction. Imaging revealed presence of a thrombus in the right atrium, extending to the SVC and IVC, with the additional findings of a left adrenal mass and multiple liver lesions. The histopathological examination of the right atrial mass revealed metastatic adenocarcinoma cells. The patient was given a presumptive diagnosis of metastatic adenocarcinoma, most likely adrenal in origin, with multiple hepatic lesions suspicious for metastasis. The clinical outcome of the patient was not favorable; the patient succumbed before the adrenal mass could be confirmed to be the primary tumor. This case highlights that in patients manifesting with extensive cavoatrial thrombus as, the existence of primary carcinoma should be considered especially in the adrenal cortex or in the lung.
authors.affiliation: Department of Biomedical Imaging, University Malaya of Research Imaging Center, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia ; Faculty of Medicine, University Teknologi MARA, Jalan Hospital, Sungai Buloh Selangor, Malaysia.
authors.forename: Bushra
authors.initials: B
authors.lastname: Johari
authors.affiliation: Department of Biomedical Imaging, University Malaya of Research Imaging Center, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Yang Faridah
authors.initials: YF
authors.lastname: Abdul Aziz
authors.affiliation: Department of Surgery, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Krishnasamy
authors.affiliation: Department of Pathology, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Lai Meng
authors.initials: LM
authors.lastname: Looi
authors.affiliation: Department of Surgery, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Shahrul Amry
authors.initials: SA
authors.lastname: Hashim
authors.affiliation: Department of Surgery, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Raja Amin
authors.initials: RA
authors.lastname: Raja Mokhtar
keywords: Cardiac Imaging Techniques; Heart Atria; Thrombosis; Tumor