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A 69 year old woman presented with a two week history of dyspnoea, chest tightness, and paroxysmal atrial fibrillation. A large mass in the left atrium (LA) was detected on transthoracic echocardiography. Transoesophageal echocardiography performed to define the mass further confirmed a non-homogenous mass measuring 6×5 cm attached to the intra-atrial septum. This mass resulted in obliteration of the LA cavity with prolapse through the mitral valve into the left ventricle during diastole (panel A: AM, atrial myxoma; LA, left atrium; LV, left ventricle; RV, right ventricle). A mean gradient of 15 mm Hg was measured across the mitral valve and severe pulmonary hypertension was detected. Coronary angiography was performed to exclude significant coronary artery disease before surgery. On angiography, notable neovascularisation of the tumour was seen as indicated by multiple small and tortuous vessels (panel B: RCA, right coronary artery; <, neovascularisation of tumour). The tumour had a rich arterial supply arising predominantly from the right coronary artery and also the left circumflex artery. Surgery was performed and the tumour (6.8×5.0×3.5 cm) was successfully excised. Histology confirmed the diagnosis of cardiac myxoma. This case demonstrates that coronary angiography can provide additional information to echocardiography for the diagnosis and evaluation of atrial myxoma, by visualising arterial supply of the tumour.
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