We present the case of a patient with an intrathoracic mass. Anthony Weetman, professor of medicine in Sheffield, comments on the case summary. A 45 year old woman presented with a three month history of dyspnoea, itchy skin, palpitations, increased sweating, loose stools, orthopnoea, and muscle weakness. On examination she looked unwell, and she had a pulse of 200 beats/min in atrial fibrillation, a jugular vein pulse raised 5-6 cm, normal heart sounds, and a central trachea with bibasal crackles. The thyroid was not palpable. Electrocardiography confirmed atrial fibrillation. Echocardiography showed trivial mitral and tricuspid regurgitation with minimally impaired ventricular function.
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