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Recurrent myxoma of the right ventricle

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A 34 year old man had three episodes of pleuritic chest pain over an 18 month period. Ventilation/perfusion scanning confirmed pulmonary emboli and he was anticoagulated. In February 1999 he presented with pleuritic chest pain again. A transthoracic echocardiogram (TTE) revealed a large, well circumscribed, echogenic mass in the right ventricle (below left and middle). At operation, the mass was seen to be densely adherent to the wall of the right ventricle but was resected. Subsequent histology confirmed the tumour to be a cardiac myxoma.  One year later the patient was readmitted with pleuritic chest pain. He had not continued with anticoagulation. Repeat TTE (below right) revealed a bright, pedunculated lesion identified on the septal wall of the right ventricle.  The mass was thought to represent a recurrence of the previous myxoma. Rather than reoperate to remove the mass, the patient was anticoagulated again with warfarin. He is to be monitored closely with regular echocardiography.  Right ventricular myxoma is a rare cardiac tumour. Limited data exists on recurrence of myxomata at any site. Regrowth following incomplete excision seems the likely mechanism for recurrence in this case. Recurrence of right ventricular myxoma has been reported once before, although it has occurred following left and right atrial myxoma.  This rare case illustrates the difficulties associated with the management of ventricular tumours. Recurrence is likely to be high unless extensive endocardial resection is performed. Secondly, the case re-emphasises the need to investigate the source of pulmonary emboli, particularly in young patients with no known risk factors.