A Man with a Clot on his Platelets: Adrenal Carcinoma and Dynamic Right Ventricular Inflow Obstruction

Adrenocortical carcinoma is a rare aggressive neoplasm that is often clinically silent until late in the disease process. A previously fit 82-year-old man presented to our service with a 4-week history of unintentional weight loss, worsening exertional dyspnea, and right-sided pleuritic chest pain. His past medical history included polymyalgia rheumatica, for which he was taking a maintenance dose of prednisolone 5 mg daily. He was a lifelong teetotaler and an ex-smoker of 30 pack-years up to the age of 50 years.