Imaging of a huge atrial myxoma
A 71 year old woman with progressive dyspnoea and exercise intolerance was found during a transthoracic echocardiography to have a huge mobile mass in the left atrium. Tentative diagnosis of left atrial myxoma was made and the patient was referred to our hospital for further evaluation and treatment.
A transoesophageal echocardiogram (upper panel, left) revealed a solid, round, and homogeneous tumour tending to prolapse through the mitral valve during diastole. An angiogram of the right pulmonary artery in the levophase (lower panel, left) showed the left heart structures and the mass (arrowheads). These findings were confirmed by magnetic resonance imaging (below, still frame of a steady state free precession (SSFP) cine sequence in the vertical long axis) (Ao, aorta; LA, left atrium; LV, left ventricle; MV, mitral valve; Myx, myxoma; PV, pulmonary veins; RA, right atrium; RV, right ventricle).
The patient was taken to the operating room for extirpation of the atrial tumour. A solid, round mass with a non-mobile surface was removed (upper and lower panels, right). The patient’s recovery was unremarkable. Anatomo-pathology confirmed the diagnosis of myxoma.
Myxoma is the most common type of primary cardiac tumour, and approximately 85% of myxomas develop in the left atrium.
Typically two distinct types of myxoma can be identified: round type characterised by a solid and round shape with a non-mobile surface; and polypoid type characterised by an irregular and soft shape with a mobile and friable surface. The latter characteristics are predictors of systemic embolism.
