Comparison of Clinical and Echocardiographic Characteristics between Cardiac Myxomas and Masses Mimicking Myxoma

Abstract

Background and objectives: Cardiac myxoma is the most frequent benign cardiac tumor that can result in cardiac and systemic symptoms. We investigated clinical and echocardiographic characteristics of patients with cardiac masses suggesting myxoma.

Methods: We investigated 265 consecutive patients with an echocardiographic diagnosis of cardiac myxomas in 4 teaching hospitals in Korea.

Results: The mean age was 61±16 years and 169 patients (63.8%) were female. The most frequent referral reason for echocardiography was an evaluation of cardiac symptoms (43.4%). Tumors were incidentally detected in 82 patients (30.9%). Left atrium (LA) was the most frequently involved site (84.5%) and 19 patients (7.2%) had non-atrial tumors. The mean tumor size was 38.7×26.0 mm (range, 4-96 mm). Of 186 patients (70.2%) who had pathological diagnosis, 174 (93.5%) were confirmed with myxoma, 8 (4.3%) with other tumors and 4 (2.2%) with thrombi. Compared to myxoma, smaller size (20.4×12.6 mm vs. 41.4×27.6 mm, p<0.01) and non-LA location (87.5% vs. 10.5%, p<0.001) were associated with non-myxoma tumors, and more frequent atrial fibrillation (AF, 75.0% vs. 7.0%, p<0.001) and larger LA diameter (55.0±14.6 mm vs. 41.3±7.7 mm, p=0.001) were related to thrombi.

Conclusions: Of 265 patients with an echocardiographic diagnosis with cardiac myxomas, 174 (65.7%) were surgically confirmed with myxomas. Compared with cardiac myxoma, other tumors were smaller and more frequently found in non-atrial sites. Thrombi were associated with AF and larger LA diameter.

Keywords: Cardiac tumor; Echocardiography; Myxoma; Thrombus.

Figure 1. A flow diagram showing the number of patients diagnosed as cardiac myxomas by transthoracic echocardiography.

Figure 2. Representative cases. (A) An incidentally detected a 64×49 mm sized myxoma with smooth surface in the LA in a 58-year old woman. (B) A myxoma with polypoid surface in the RA prolapsing through the TV in a 53-year old man. (C) A transesophageal echocardiographic image showing an irregular shaped myxoma measured 34×9 mm in size originating from the left upper PV in the LA cavity in a 72-year old woman with a history of AF and cerebral infarction 3 years ago. (D) An 84×67 mm-sized mass-like thrombus in the LA in a 75-year old man with a history of AF presenting with abdominal pain. (E) A 14×13 mm-sized round echogenic mass below the medial mitral annulus in the LA in a 77-year old woman presenting with chest pain diagnosed as hemangioma. (F) A 22×21 mm-sized round mass proven to be a PFE below the septal leaflet of the TV in the RA in a 72-year old woman presenting with chest pain. Arrows indicate myxomas and masses mimicking myxoma.

AF = atrial fibrillation; LA = left atrium; PFE = papillary fibroelastoma; PV = pulmonary vein; RA = right atrium; TV = tricuspid valve.