Myxoma

Background

A myxoma: a gelatinous tumor attached by a narrow pedicle to the atrial septum. The myxoma has an irregular surface and nearly fills the left atrium.

• Most common primary cardiac neoplasm
• ~80% of myxomas originate in the left atrium, with the remainder in the right atrium

Clinical Features

• Cardiovascular symptoms mimicking mitral valve obstruction (e.g., left atrial hypertrophy)
• Increased risk of systemic embolization
• Constitutional symptoms (e.g., fever, weight loss)

Evaluation

(A) Cardiac MRI showing atrial myxoma during systole. (B) Cardiac MRI showing atrial myxoma during diastole. RA – right atrium; RV – right ventricle; LA – left atrium; LV – left ventricle; arrow – myxoma.

Left atrial myxomas. (a) Parasternal long-axis view showing wedging of the myxoma into the mitral valve; (b) same case (four chamber view); (c) three-dimensional transesophageal echocardiography visualization of a left atrium myxoma attached to the posterior wall of the left atrium proximal to the pulmonary vein; (d) transesophageal echocardiography four chamber view of a large left atrium myxoma obstructing the mitral valve.

Workup

• Transthoracic echocardiogram
• Transesophageal echocardiogram
• Cardiac MRI

Diagnosis

• Typical location of myxomas is amenable to visualization with TTE

Management

• Once presumptive diagnosis made, prompt resection is required due to elevated risk of embolization or cardiac complications

Disposition

• Most often admit for further management including potential anticoagulation and resection