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A woman in her 60s was referred with dyspnoea and recurrently unexplained large pericardial effusion in the past 2 years. Physical examination found xanthoma around the orbital area, lower extremities oedema, and no enlarged lymph nodes. Laboratory tests found elevated serum brain natriuretic peptide level of 1058 pg/mL and normal IgG4 of 0.39 g/L. The pericardial effusion was exudate, and no tumour cells were found. Echocardiography showed large pericardial effusion and irregular right atrial (RA) mass. The cardiac magnetic resonance (CMR) examination found infiltrating mass in the right atrium (figure 1A, arrows) with positive late gadolinium enhancement (LGE) (figure 1B, arrows). The mass showed shorter T1 relaxation times compared with left ventricular myocardium (figure 1C). The abdominal enhanced MRI found thickened wall with diffused enhancement in abdominal aortas, and brain MRI found two subdural tumours. Single photon-emission CT found bilaterally increased uptakes in the …
PY and ZC contributed equally.
Contributors YC initiated the study, defined its design and reviewed the manuscript. PY and ZC involved in the process of diagnosis, treatment and follow-up of the patient. PY acquired the image and clinical data, read the images and drafted the manuscript. ZC revised language of the manuscript. All authors read and approved the final manuscript.
Funding This study is funded by Project for Disciplines of Excellence, West China Hospital (ZYJC18013), China Postdoctoral Science Foundation (2019M663523), National Natural Science Foundation of China (82000353).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.
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