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A 60-year-old woman presented with breathlessness for 6 months. On examination, she had dilated veins in the neck and chest with direction of blood flow downwards suggesting superior vena cava (SVC) obstruction (figure 1A). Chest auscultation revealed diminished breath sounds on the right side. Chest X-ray showed mediastinal widening with soft-tissue density lesion in upper-right hemithorax (figure 1B). Transthoracic echocardiogram showed globular mass in right atrium (RA) obstructing the tricuspid valve (figure 1C and online supplementary video 1). Transoesophageal echocardiogram revealed the mass extending from SVC and filling the RA (figure 1D,E-asterix …
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