A retrocardiac mass unveiled by a can of soda

A 75-year-old female presented to the outpatient clinic with complaints of retrosternal pain. The electrocardiogram was normal. Exercise testing was within normal limits. Transthoracic echocardiography showed normal dimensions and normal valvular and ventricular function. A mass-like lesion was visible near the left posterior atrioventricular junction in all echocardiographic views (figure 1A). Differential diagnosis included intracardiac thrombus, intracardiac tumour, extracardiac tumour, dilated descending aorta and hiatal hernia. Computed tomography (CT) of the thorax revealed a large hiatal hernia, extending far into the retrocardiac region (figure 2). This diagnosis was confirmed by repeat echocardiography after having the patient drink a carbonated beverage in the recumbent position. Contrast bubbles were clearly visible inside the retrocardiac ‘mass’ after ingestion of the carbonated fluid (figure 1B). …