A 58 year old woman was treated for chronic depression with many non-specific thoracic complaints during many years. The previous few months she had complained of progressive dyspnoea. Furthermore she sometimes had “panic attacks” with dyspnoea and dizziness.

Since her chest x ray revealed a moderately enlarged heart silhouette (panel A) she was referred to the cardiologist. An ultrasound examination demonstrated a giant intracardiac tumour in the right atrium (panel B, video 1). Additional coronary angiography demonstrated the vascularisation of the tumour (panel C, video 2) after which it was surgically removed (to view video footage visit the Heart website—http://www.heartjnl.com/supplemental). Pathology confirmed the diagnosis of myxoma. The patient’s recovery was uneventful and after six months she experiences less dyspnoea and the dyspnoea attacks and the dizzy spells do not occur as frequently as before.

In psychiatric patients it is often difficult to discriminate cardiac symptoms that may be well explained by psychiatric disease. Fortunately in this case a simple chest x ray led to the correct diagnosis.