Contrast-enhanced right atrial mass: tumour or thrombus?

We present a case of a 61-year-old female diagnosed with soft-tissue fibrosarcoma of the shoulder with a right atrial mass on transthoracic echocardiogram. To further assess the mass, contrast transoesophageal echo was performed. The mass was highly considered to be a thrombus due to the presence of multiple risk factors: atrial fibrillation, catheter use, and pulmonary embolism. However, a metastatic fibrosarcoma could not be excluded, given its enhancement with echo contrast. Finally, it was proved to be a thrombus with its rapid resolution while on anticoagulation. Therefore, it should be noted that in rare circumstances, thrombus may show enhancement with echo contrast and one needs to integrate all of the patient information to arrive at the correct diagnosis.