Fluctuating Cutaneous Varices as a Diagnostic Clue for a Huge Right Atrial Mass in a Dialysis Patient

A 72-year-old man presented with altered consciousness. His past medical history included left renal cell carcinoma status post nephrectomy 3 years earlier, end-stage renal disease with regular hemodialysis, and central venous obstruction with stenting at the right subclavian vein and superior vena cava 8 months earlier. He was intubated and placed on a mechanical ventilator and inotropes for managing respiratory failure and shock. After numerous tests, it was evident that a right atrial mass was hindering blood flow into the right ventricle and causing blood to flow back into the peripheral venous system. This could cause obstructive cardiogenic shock and fluctuating cutaneous varices. The patient refused further intervention and died from multiple organ failure. This unusual phenomenon can provide a clue for the discovery of atrial masses in dialysis patients.