Echo Lucent Space Occupying Lesion on Echocardiogram

Left atrial space occupying lesions pose diagnostic challenge on echocardiography. We report a 79-year-old man with history of pheochromocytoma with left adrenal mass presented with heart failure symptoms after adrenalectomy. Echocardiogram revealed a large echo lucent structure (6.9 x5.9cm) compressing the posterior wall of the left atrium. Further investigation with computer tomography and barium swallow confirmed the diagnosis of hiatal hernia. In this report we explain the differential diagnosis and simple steps to assist the diagnosis of left atrial space occupying lesions noninvasively.