Large Right Atrial Myxoma Presenting As Bilateral Pulmonary Embolism

Abstract

Myxoma is a rare benign tumor of the heart. Cardiac myxomas are the most common primary cardiac tumor in adults, commonly found within the left atrium. It can occur at any age and is more common in females than males. This case report aims to identify the clinical symptoms of cardiac myxoma, which can be life-threatening if neglected. Here, we present the case of a 30-year-old female with past smoking history. For the past three to four weeks before this hospitalization, her symptoms worsened including shortness of breath with exertion, dry cough, and pleuritic chest pain. Outpatient treatment with antibiotics and nebulizers did not relieve her symptoms. She went to the emergency room and underwent computed tomography of the chest with contrast showing bilateral lower lobe pulmonary emboli and a large mass in the right atrium. Intravenous unfractionated heparin was initiated. A transthoracic echocardiogram confirmed a 3.76 cm × 4.95 cm mass in the right atrium. The patient underwent surgical resection of the right atrial mass the following day and was discharged four days later in a stable condition. Pathology of the mass confirmed atrial myxoma.

Keywords: acute pulmonary embolism; benign cardiac tumor; cardiac tumor in adults; mass resection; right atrial myxoma.

Figure 1. Chest X-ray showing normal lungs, with no consolidation or pleural effusion and normal cardiac silhouette.

Figure 2. CT of the chest with contrast showing a small right lower lobe pulmonary embolism (yellow arrow).

CT: computed tomography

Figure 3. CT of the chest with contrast showing a small left lower lobe pulmonary embolism (yellow arrow).

CT: computed tomography

Figure 4. CT of the chest with contrast showing a 4.5 cm mass in the right atrium (red arrow).

CT: computed tomography

Figure 5. Transthoracic echocardiogram with RV inflow window showing a large mass measuring 3.7 × 4.9 cm.

RV: right ventricular

Figure 6. M-mode recording demonstrating the mass prolapsing into the RV during diastole “tumor plop” (yellow arrow).

RA: right atrium

Figure 7. Stellate-shaped myxoma cells. H&E stain (original magnification ×400).

H&E: hematoxylin and eosin