A 72-years old woman was admitted to our department for a long lasting (3-hours) thoracic pain episode and increasing palpitations during the last month. At admission clinical examination was unremarkable and laboratory test showed slightly increased urinary as well as plasma levels of catecholamines. Transthoracic echo (Fig. 1, panel A-B) showed a vascularized, hypo-echoic mass with a central hyperechoic region that did not appear to interfere with flow (Online Video 1) in the great vessels. Subsequent CT scan confirmed the presence of a 6 × 7 cm mass with a central necrotic core, located under the aortic arch, over the pulmonary trunk (Fig.
