Atypical Presentation of a Right Atrial Myxoma

Abstract

Primary cardiac tumors are exceptionally rare and predominantly located in the left atrium with occasional involvement on the right side of the heart. We present the case of a 52-year-old man who presented with chest pain, leading to suspicion of acute coronary syndrome. However, further investigation revealed a right atrial tumor measuring 6.3 cm. After surgical removal, the pathology analysis of the mass confirmed the histology of myxoma. Differential diagnoses for atrial myxomas include thrombus and other tumors, such as rhabdomyomas. More than half of these tumors arise in the left atrium and may be complicated by neurologic symptoms secondary to embolization. Right atrial myxomas are rare and described in the literature with a myriad of symptoms (signs of right heart failure [i.e., fatigue, peripheral edema, hepatomegaly, ascites], a diastolic murmur, and symptoms of pulmonary emboli). In other cases, they may be asymptomatic. Due to the low incidence and variety in their clinical picture, careful documentation of these cases is suggested for early recognition and directed management.

Keywords: cardiac tumor in adults; cardiothoracic & vascular surgery; pathology slides; right atrial myxoma; surgical case reports.

Figure 1. Transverse view of CT of chest

Transverse view of CT of chest showing a mass in the cardiac area with calcifications (yellow arrow).

Figure 2. Tumor blush of irrigation of the mass by the LCX (yellow arrow)

LCX = left circumflex artery.

Figure 3. Gross specimen analysis of the resected mass

Gross specimen analysis revealed a lobulated, mottled, brown to yellow-red mass of rubbery tissue.

Figure 4. Pathology analysis of the cardiac mass

Histological analysis displayed areas of old hemorrhage obscuring neoplastic cells (A, B) and syncytial aggregations of bland pink stellate cells surrounded by a myxoid stromal matrix (C, D).