A 19-year-old male, with history of hypothyroidism, presented with progressive dyspnea along with pedal edema and abdominal distention over 2 years. In the cardiology outpatient setting, transthoracic echocardiography (TTE) revealed pulmonary stenosis, tricuspid regurgitation (TR), dilated right atrial (RA), dilated right ventricle (RV), RV dysfunction and spontaneous echo contrast (SEC) in the RA. There was a sessile mass in the RA near the superior vena cava-right atrial (SVC-RA) junction. Computed tomography (CT) and magnetic resonance imaging (MRI) were not done as the mass was presumed to be a thrombus in view of it being sessile, not related to the interatrial septum, proximity to the RA appendage, and presence of SEC. The patient was diagnosed as having congenital pulmonary stenosis with concomitant TR and a thrombus in the RA. He was started on heparin for thrombolysis and referred to the cardiac surgical team.
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