BACKGROUND Cardiac masses have a wide range of etiologies with the most common being thrombi and less commonly tumors. However, in Sub-Saharan Africa other etiologies not commonly seen in developed countries such as endomyocardial fibrosis (EMF) must be considered. EMF is a disease process associated with poverty, a poor diet, and eosinophilia although its pathology is poorly understood. METHODS We report a case of a 53-year-old male with a history of dilated cardiomyopathy who presented to a Ugandan Emergency Department in respiratory distress. Bedside echocardiography was performed which revealed a large mass in the apex of the left ventricle. The patient was subsequently given supplemental oxygen and intravenous furosemide, however he later died while in the emergency department due to limited resources and lack of definitive care. CONCLUSIONS The list of potential etiologies of cardiac masses is widely variable, and in settings such as Sub-Saharan Africa, this list must be expanded to include possible diagnoses such as EMF. EMF is a diagnosis that should be considered in patients presenting with respiratory distress and a cardiac mass present on echocardiography, such as the case presented here. The limited opportunities for medical personnel to diagnose cardiovascular disease can be made more efficient by the use of diagnostic imaging devices which are portable, yet capable of diagnosing the most common local pathologies [9-11].