Giant Intrapericardial Myxoma Adjacent to the Left Main Coronary Artery

Abstract

A 62-years-old woman was admitted to the hospital because of chronic cough, expectoration of thick mucus, hoarseness and tightness in the precordial area. Computed Tomography (CT) examination revealed the presence of a giant intrapericardial tumor with the dimensions of 80 × 38 × 32 mm. It was located anteriorly and laterally to the left atrium, posteriorly to the pulmonary trunk and the ascending aorta. This hypodense change modeled the left atrium without evidence of invasion. CT coronary angiography and 3-dimensional reconstruction were applied to enable precise planning of cardiac surgery. CT evaluation confirmed that it is possible to remove the tumor without damage to the adjacent left main coronary artery. The patient underwent cardiac surgery with sternotomy and cardiopulmonary bypass. A cohesive, smooth, vascularized tumor pedunculated to the left atrial epicardium was visualized. The location and dimensions corresponded to those determined by CT scan examination. The entire tumor was successfully dissected together with adjacent adipose and fibrous tissue. Histological evaluation revealed the presence of myxoid cells, blood vessels, degenerative changes, and microcalcifications embedded in profuse hyalinized stroma. Those histological features enabled identification of the intrapericardial tumor as a myxoma. Follow-up CT examination did not demonstrate any signs of recurrence of the myxoma. According to our knowledge, a myxoma located inside the pericardial sac has never been described before.

Keywords: cardiac tumor; coronaries; intrapericardial mass; intrapericardial tumor; myxoma.

Figure 1

Chest computed tomography. (A) Transverse section. The intrapericardial tumor (asterisk) lies between ascending aorta (AAo), pulmonary trunk (PT), and left pulmonary vein (LPV). It contains two macrocalcifications (white arrows) and is modeled by the left main coronary artery (black arrow). (B) Coronal section. Left atrium (LA) is slightly compressed by the tumor without any signs of invasion. Left ventricle (LV) models inferior part of the tumor, PT models its superior part.

Figure 2

Heart computed tomography, 3-dimensional reconstruction. (A) The tumor (asterisk) is located posteriorly and laterally to the pulmonary trunk (PT) and the ascending aorta (AAo), superiorly to the left ventricle (LV). (B) Macrocalcificacion (black arrow) as a part of the tumor's structure.

Figure 3

Intraoperative image and histopathology of the tumor. (A) Cardiac surgery. Transverse intersection of the aorta and the pulmonary trunk exposed the intrapericardial tumor (asterisk). (B) Macroscopic section of bisected mass. The scale indicates its longitudinal dimension of 75 mm. (C) Microscopic section. Hematoxylin and eosin-stained histology image of the tumor. A blood vessel surrounded by myxoid cells (black arrow). Microcalcifications and degenerative changes are embedded in profuse hyalinized stroma (white arrow).