Unexplained extensive calcification of the venae cavae extending into the right atrium causing partial obstruction of the tricuspid valve

A 23-year-old woman, who had been diagnosed recently with hypothyroidism, was referred to us for an echocardiogram. She was apparently asymptomatic when she developed fatigue and mild generalised oedema. She did not have any history of chest pain, breathlessness, palpitation or syncope. Her echocardiogram revealed the following very unusual finding (figure 1, video 1). A large, irregular, highly echogenic mass was seen in the right atrium (RA), partially prolapsing through the tricuspid valve (TV) in diastole. There was mild obstruction of the TV as evidenced by increased velocity gradients across the valve. The mass seemed to be in continuity with a highly echogenic structure lining the inferior vena cava (IVC) (figure 2). Rest of the cardiac structures were normal. There was no cardiac enlargement or pericardial effusion. No evidence of pulmonary hypertension was seen. There was no history suggestive of pulmonary embolism. She underwent a …