Loud Systolic and Diastolic Murmurs Originating on a Right Atrial Metastatic Tumor

A 36-year-old asymptomatic man, who two months before had a normal clinical examination, developed two loud, grade 5/6 harsh systolic and diastolic murmurs, audible over the entire precordium. Two-dimensional echocardiography revealed a huge tumoral mass, attached to the right atrium near the tricuspid valve, pedicellated and of great mobility, reaching the right ventricular outflow tract during diastole, and coming back to the atrium in systole. Right-sided angiography confirmed the diagnosis, and after ablation of the tumor, the auscultation was normal again. Two loud murmurs constitute a quite uncommon manifestation of an intracavitary mass, and this unusual finding has not previously reported in the medical literature available to the authors.