Hypoxemia associated with right-side cardiac tumor: right atrial lymphoma with patent foramen ovale

A 66-year-old man presented with acute type I respiratory failure, and was diagnosed to have a huge mass occupying the right atrium (RA) of the heart, with no evidence of pulmonary embolism. Intra-operative transesophageal echocardiogram identified a patent foramen ovale (PFO) with right-to-left shunt apart from a huge right atrial tumor arising from the atrioventricular groove. The tumor was debulked, and the patent foramen was closed. Patient had an uneventful recovery and WAS discharged on post-operative day 7. Pathology revealed diffuse large B-cell lymphoma (DLBCL). The patient was further treated with adjuvant chemotherapy and remained well 1 year after surgery. This case illustrates the importance of meticulous echocardiographic examination to look for any intracardiac shunts in the case of hypoxemia associated with a right-sided cardiac tumor. We advocate surgery as the most important initial management to maximize survival, as it allows correction of any hemodynamic sequelae, and simultaneous attainment of definite histological diagnosis for guidance of adjuvant therapy.