Summary: | Right atrial mass could be a tumor, thrombus, or vegetation, and it often poses a diagnostic dilemma. Accurate diagnosis is crucial to planning the correct management strategy. However, despite the advanced and sophisticated diagnostic modalities available, differentiating intracardiac masses could still be challenging. Clinical presentation leads to the appropriate conduit of investigations, and histopathology is confirmatory. When the diagnostic dilemma persists even after all efforts, clinical scenario should be strongly reconsidered, especially in unique clinical settings before concluding a diagnosis. In this article, the authors describe the case of a young woman with history of peripheral arterial thrombosis, who underwent surgical excision of a right atrial mass diagnosed as right atrial myxoma. She later presented with massive pulmonary embolism and deep vein thrombosis of the lower limbs. In view of her extensive thrombotic history, her entire case was reviewed including the histopathology slides, and the diagnosis of right atrial thrombus was considered and confirmed. On further workup for thrombotic state, she was found to have protein C deficiency.
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