A 48-year-old female with a past medical history of opioid use disorder on suboxone presents with abdominal pain for one day. The patient developed sharp diffuse upper abdominal pain the evening prior to arrival that resolved. The pain recurred again today and was associated with bilious emesis. The patient notes persistent upper abdominal pain with paroxysmal exacerbation. She has a history of a hysterectomy, but no other abdominal surgeries. No history of gallstone pathology.
An echo was performed for bradycardia and a brief episode of hypoxia in the emergency department. A large, tethered mass is seen likely originating from the left atrium. This finding is most consistent with an atrial myxoma, though it can also represent a clot. The patient was ultimately diagnosed with gallstone ileus and an atrial myxoma.