Right atrial tumor seen on transthoracic echocardiography from the apical 4 chamber view

The apical four chamber view shows a tumor mass (arrows) extending into the right ventricle (RV) from the right atrium (RA). This large mass occupies most of the RA and extends across the tricuspid valve into the inlet portion of the RV. Finding a mass of this sort should direct the examination at the inferior vena cava because an abdominal malignancy with intravascular extension is the usual origin. This particular tumor was a renal cell carcinoma.