Hepatoma associated with a floating right atrial mass

A 68-year-old male with hepatoma and a systolic cardiac murmur was found to have a free-floating mass in the right atrial cavity on echocardiographic examination. Hepatoma with right atrial metastasis was suspected. Surgical intervention was refused. On the 18th day after admission to hospital, the patient suffered sudden onset of dyspnea, followed by hypotension and engorged jugular veins. The patient died a few hours later from intractable hypotension. It was assumed that the catastrophic event was due to sudden obstruction of the right side of the heart by the moving mass or to massive pulmonary embolism. Autopsy was not performed.