A rare cause of a right atrial mass

This 62 year-old gentleman presented with increasing shortness of breath on exertion and reduced exercise tolerance (NYHA class III). Brain natriuretic peptide and D-dimer were markedly elevated. ECG showed no evidence of acute ischaemia. There was a history of gastro-oesophageal reflux disease and excessive alcohol consumption 8 years previously. He was an ex-smoker with a 20 pack year history.