A Man with Dyspnea, Edema, and Pacemaker-Lead Displacement

Two months prior, a pacemaker had been placed for sinus arrest; transthoracic echocardiography at that time was normal. Progressive dyspnea and edema prompted pacemaker interrogation and imaging, which showed loss of atrial lead capture with lead position change. Multimodal imaging revealed a large right atrial mass encasing the lead along and a coronary artery, along with mediastinal lymphadenopathy, pleural and pericardial effusions, and segmental pulmonary emboli.