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A patient with pulmonary embolism and a mass in the left atrium
  1. Reto Nägele,
  2. Piero Ovidio Bonetti,
  3. Kurt Albert Mayer
  1. Division of Cardiology, Kantonsspital Graubuenden, Chur, Switzerland
  1. Correspondence to Dr Kurt A Mayer, Division of Cardiology, Kantonsspital Graubuenden, Loëstrasse 170, CH-7000 Chur, Switzerland; kurt.mayer{at}ksgr.ch

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Case

A 58-year-old woman was admitted to our hospital because of increasing exertional dyspnoea over the last months and clinical signs of right heart failure. The patient had no history of cardiovascular or pulmonary disease. Contrast-enhanced thoracic CT confirmed the suspected diagnosis of pulmonary embolism with embolic fragments in the segment arteries of the left inferior lobe. In addition, CT revealed a mass in the left atrium (LA). A venous Doppler examination of the lower limbs was normal. Transthoracic echocardiography confirmed the presence of a large, solid mass in the LA (6×4×4 cm), which partially occluded the mitral valve orifice causing a ‘dynamic’ mitral stenosis and protruded into the right atrium through a large type II atrial septal defect (ASD) (figure 1). Consecutively, the patient was referred for surgery. The tumour, which originated from the interatrial base of the LA, was successfully resected (figure 2) and the ASD was closed with a pericardial patch. The histopathological study identified the tumour as myxoma. The postoperative course was uneventful.

Figure 1

Diastolic frame of apical four chamber view showing a large mass (6×4×4 cm) in the left atrium occluding the mitral valve orifice and protruding into the left ventricular cavity (star) and into the right atrium through a large type II atrial septal defect (arrow).

Figure 2

Postoperative gross pathology specimen of left atrial myxoma.

Atrial myxoma is a benign tumour and represents the most frequent primary neoplasm of the heart. The majority of these lesions are of sporadic origin and located in the LA. Systemic embolism occurs in 10–20% of the cases. In our patient, we assume that the left-sided myxoma was the source of pulmonary embolism due to reverse paradoxical embolism through a coexistent ASD.1

Reference

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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