CLINICAL IMAGE
Atrial mass: a myxoma? Andrew C. Chatzis, Kostas Kostopanagiotou, Theofili Kousi & Fotios Mitropoulos Department of Paediatric and Congenital Cardiac Surgery, Onassis Cardiac Surgery Centre, Athens, Greece
Correspondence Andrew Chatzis, Department of Paediatric and Congenital Cardiac Surgery, Cardiac Surgery Centre, 356 Syngrou Ave., Kallithea 17674, Athens, Greece. Tel: +30-2109493318; Fax: +30-2109493887; E-mail:
[email protected]
Key Clinical Message
Funding Information No sources of funding were declared for this study.
Keywords
A middle-aged woman with a history of resected colorectal cancer and receiving chemotherapy presented with a right atrial mass and the provisional diagnosis of myxoma supported by echocardiography, computed tomography, and magnetic resonance imaging. Successful surgical removal revealed organized thrombus instead. Atrial thrombus may be mistaken for myxoma and long-term intracardiac indwelling catheters can be thrombogenic.
Atrial thrombus, atrial myxoma, intracardiac indwelling catheters.
Received: 9 February 2016; Revised: 14 May 2016; Accepted: 16 June 2016 Clinical Case Reports 2016; 4(8): 842–843 doi: 10.1002/ccr3.626
Case History A 50-year-old Caucasian woman with a history of a resected colorectal cancer was receiving chemotherapy for about 6 months. During routine follow-up, a right atrial mass was picked up by echocardiography (Fig. 1A). Complete investigational work-up with computed tomography
(A)
(Fig. 1B) and magnetic resonance imaging (Fig. 1C) revealed a tumor adherent to the right atrial free wall with a distinct stalk. The provisional diagnosis of myxoma was made and surgery was advised. The patient underwent cardiac surgery with cardiopulmonary bypass support and cardioplegic arrest. Following right atriotomy, a pediculate mass was found strongly
(B)
(C)
Figure 1. Right atrial (RA) pediculate mass signified by arrows as depicted by means of ECHO (A), CT-scan (B), and MRI (C).
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ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
A. C. Chatzis et al.
Atrial mass
Organized thrombus with a distinct stalk mimicking myxoma has been reported before in patients with some form of cardiac disease especially atrial fibrillation [2]. Right atrial thrombus formation in the absence of cardiac disease, nevertheless, raises questions regarding anticoagulation protocols that may have to take into consideration the presence of intra-atrial indwelling catheters.
Conflict of Interest None declared. References
Figure 2. Resected mass.
adherent to the right atrial free wall opposite the indwelling Hickman catheter. This was successfully excised en block with part of the atrial wall (Fig. 2). Histology, however, showed organized thrombus. Despite modern available imaging modalities, it may be difficult to differentiate between atrial masses [1].
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
1. Khalid, U., P. Hirudayaraj, N. Lakkis, and R. Tabbaa. 2014. Left atrial thrombus mimicking a myxoma in a patient with systemic lupus erythematosus. Hellenic J. Cardiol. 55:167– 170. 2. Hesse, B., R. T. Murphy, J. Myles, J. Huang, and E. M. Sabik. 2006. Images in cardiovascular medicine. A left atrial appendage thrombus mimicking atrial myxoma. Circulation 113:e456–e457.
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