A Case of Rapidly Growing Cardiac Myxoma Within a Year Causing Heart Failure

Nam, Dong-Hyun; Lee, Jaewon; Kim, Hyuck; Heo, Ran

doi:10.4250/jcvi.2022.0034

J Cardiovasc Imaging. 2023 Jan;31(1):65-67. English.
Published online Jul 12, 2022.
https://doi.org/10.4250/jcvi.2022.0034

Case Report

A Case of Rapidly Growing Cardiac Myxoma Within a Year Causing Heart Failure

Dong-Hyun Nam, MD,¹^,^* Jaewon Lee, MD,¹^,^* Hyuck Kim, MD, PhD,² and Ran Heo

, MD, PhD¹^,³

Author information

Author notes

Copyright and License

- ¹Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea.
- ²Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hanyang University, Seoul, Korea.
- ³Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
Address for Correspondence: Ran Heo, MD, PhD. Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. Email: cardiohr@hanyang.ac.kr

^*Dong-Hyun Nam and Jaewon Lee are equally contributed to this work.

Received March 11, 2022; Revised June 14, 2022; Accepted June 26, 2022.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

A 54-year-old female visited the emergency department due to dyspnea for 3 weeks. Physical examination revealed a clear breathing sound and regular heart sound with a mid-diastolic murmur. Chest X-ray demonstrated mild cardiomegaly. Laboratory findings showed mildly elevated brain natriuretic peptide (187 pg/mL). Her transthoracic echocardiography (TTE) for health check-up was unremarkable 10 months ago (Movie 1).

However, TTE revealed a mobile, echogenic mass in LA which caused severe mitral stenosis (Figures 1, 2A and B, Movies 2 and 3). Transesophageal echocardiography showed a 6.0 × 4.4 cm-sized, multi-lobulated mass attached at LA (Figure 2C, Movies 4 and 5). Computed tomography (CT) revealed a large, low attenuated filling defect with a volume of 46.8 cm³ in LA (Figure 2D). Based on the findings from echocardiography and CT, we diagnosed myxoma which caused functional mitral stenosis and heart failure. Mass excision surgery was done considering its size and hemodynamic significance. Excised mass was confirmed as myxoma pathologically (Figure 3). Postoperative TTE found normal mitral function with complete resection of the previous mass.

Figure 1
Comparison of echocardiographic images. (A) No abnormal mass in LA 10 months ago. (B) LA mass suggestive of myxoma.
LA: left atrial.

Figure 2
Transthoracic echocardiography demonstrated a mobile, echogenic mass in LA (A) causing severe mitral stenosis (B). Transesophageal echocardiography image of mid-esophageal 180° view showed 6.0 × 4.4 cm-sized, multi-lobulated mass attached at LA (C). Computed tomography angiography image revealed a large mass in LA (D).
LA: left atrial.

Figure 3
Pathologically confirmed myxoma. Histology showed multi-lobulated structures with myxoid stroma (hematoxylin and eosin staining).

The growth rate of a cardiac myxoma has been reported variously. In a case of myxoma, its size increased approximately 7-fold during 6 years.1) In another case followed up for nearly 30 years, the size of the myxoma was increased then decreased.2) Our case highlights a rare cause of heart failure due to a large myxoma with an exceptional growth rate confirmed by a multi-imaging modality.

Written informed consent was obtained from the patient for publication of this article.

SUPPLEMENTARY MATERIALS

Movie 1

No intra-cardiac mass in previous transthoracic echocardiography 10 months ago.

Click here to view.^{(6M, mp4)}

Movie 2

Echogenic mass in the left atrium from parasternal-long axis view.

Click here to view.^{(288K, mp4)}

Movie 3

Echogenic mass in the left atrium from apical 4-chamber view.

Click here to view.^{(226K, mp4)}

Movie 4

Transesophageal echocardiographic image; echogenic, huge, multi-lobulated mass in the left atrium with 2D image.

Click here to view.^{(251K, mp4)}

Movie 5

Transesophageal echocardiographic image: echogenic, huge, multi-lobulated mass in the left atrium with 3D image.

Click here to view.^{(306K, mp4)}

Notes

Conflict of Interest:The authors have no financial conflicts of interest.

Author Contributions:

Conceptualization: Lee J.
Writing - original draft: Nam DH, Lee J.
Writing - review & editing: Nam DH, Lee J, Kim H, Heo R.

References

1. Abdulmajid L, El Addouli H, Paelinck B, De Bock D. Natural growth of left atrial myxoma. Ann Thorac Surg 2021;111:e275–e277.
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1. Elsherif Z, Mahmood N, Ahmed AM. 30-year follow-up of an unoperated left atrial myxoma: a case report. Eur Heart J Case Rep 2020;4:1–5.
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