Prolapsing Atrial Myxoma
Dynamic Visualization With Multislice Computed Tomography
An 80-year-old woman had a history of increasing dyspnea with a sensation of thoracic pressure. Transthoracic echocardiography demonstrated a mobile hyperechoic mass located in the left atrium (Figure 1A) and prolapsing into the left ventricle (Figure 2A). A moderate obstruction of the mitral valve was observed. The mass was suspicious for a cardiac tumor, although an additional thrombus formation could not be excluded. Accordingly, a contrast-enhanced, ECG-gated, 16-row helical CT scan (Sensation 16, Siemens) demonstrated a hypodense mass based on the atrial septum (Figure 1B). Homogenous contrast enhancement suggested a cardiac tumor. Dynamic visualization of the cardiac motion showed the mass based on the atrial septum, prolapsing during diastole into the left ventricle (Figure 2B and Data Supplement Movies). Three-dimensional image reconstruction dependent on heart phase (end diastole and end systole) with ECG gating and high temporal resolution (250 ms) improved preoperative assessment. Surgical removal of the mass proved it to be a myxoma. The postoperative course was uneventful.
Movies I and II are available in the online-only Data Supplement at http://www.circulationaha.org.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.