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- accident and emergency medicine
- adult cardiology
- adult intensive and critical care
A 46-year-old man, with acute-on-chronic hepatic failure and dilated cardiomyopathy, was admitted in the intermediate care unit after a sudden episode of dyspnoea without hypotension but with an elevated lactate of 3.9 mmol/L. He had an international normalised ratio of 3 and decreased factor V of 32.9%.
A bedside echocardiogram, while on sinus rhythm, revealed a mobile right atrial mass (figure 1A,B; see videos in supplementary material). Both ventricles were dilated with severely depressed function. No thrombi were present in a previous examination, 3 days before.
Contributors MLV and TM performed the echocardiogram; MLV wrote the first draft; RMF, TM and FS revised the article and added content to it.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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