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<p class="first" id="d17685685e212"> <b>Background:</b> The clinical manifestations of cardiac masses are diverse and lack specificity. Here we report a cardiac mass detected by transthoracic echocardiography. Multimodality imaging and pathological findings after the operation confirmed the mass as mediastinal tuberculoma. </p><p id="d17685685e217"> <b>Case presentation:</b> A 45-year-old male patient was admitted to our hospital reporting chest tightness, weight loss, and dyspnea for 3 months after exercise. Transthoracic echocardiography showed that there were a large number of pericardial effusions and a soft tissue mass measuring 7.7 cm × 4.5 cm in the upper mediastinum, which oppressed the right pulmonary artery and accelerated the blood flow of the left pulmonary artery. Contrast-enhanced ultrasonography showed degenerative inhomogeneous high enhancement of and an unclear boundary in the mass. Contrast-enhanced chest CT revealed punctate and patchy calcification in and uneven enhancement of the mass and the lymph nodes around the aortic arch. The mass was diagnosed as a malignant mediastinal tumor. Pathological analysis of the mass revealed chronic granulomatous tuberculosis. The symptoms abated significantly after antituberculosis treatment. The patient remained asymptomatic during follow-up. </p><p id="d17685685e222"> <b>Conclusion:</b> This report presents a rare case of mediastinal tuberculoma mimicking a malignant cardiac tumor. Multimodality imaging should be incorporated for differentiation of cardiac masses. </p>