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A 45 year old woman presented with shortness of breath and ankle swelling. She smoked 20 cigarettes a day and had recently completed an alcohol detoxification programme. A diagnosis of cardiac failure was made, with alcoholic cardiomyopathy a possible cause. However an echocardiogram was performed which revealed a more unusual cause for her cardiac failure. This showed a mass pressing against the left atrium (see fig 1). Histological examination revealed a squamous bronchial carcinoma. The tumour was inoperable because of metastatic spread. She underwent palliative radiotherapy and died four months after the initial diagnosis.