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Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 181-182

Angiocardiographic Demonstration of Right Atrial Myxoma


1 Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Cardiothoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission12-Nov-2020
Date of Acceptance01-Feb-2021
Date of Web Publication08-Apr-2021

Correspondence Address:
Dr. Krishna Prasad
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_79_20

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How to cite this article:
Panda P, Prasad K, Jaswal V, Gupta K, Pruthvi C R, Santosh K, Bootla D, Sharma YP. Angiocardiographic Demonstration of Right Atrial Myxoma. J Indian Acad Echocardiogr Cardiovasc Imaging 2021;5:181-2

How to cite this URL:
Panda P, Prasad K, Jaswal V, Gupta K, Pruthvi C R, Santosh K, Bootla D, Sharma YP. Angiocardiographic Demonstration of Right Atrial Myxoma. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2021 [cited 2021 Nov 29];5:181-2. Available from: https://www.jiaecho.org/text.asp?2021/5/2/181/313377

A 52-year-old male with no previous medical history presented to us with dyspnea on exertion, fever, and loss of weight. Echocardiogram revealed a large pedunculated echogenic mass in the right atrium (RA), attached to the interatrial septum and prolapsing into the right ventricle during diastole [Figure 1]a, [Figure 1]b and [Video 1]. A cineangiogram with injection at the junction of the inferior vena cava with RA revealed a large filling defect in the RA that was prolapsing into the right ventricle during diastole. Coronary angiogram revealed normal coronaries with multiple dilated branches supplying the tumor with associated tumor blush [Figure 1]c, [Figure 1]d and [Video 2], [Video 3]. The patient underwent surgical excision of the mass, and histopathological examination was suggestive of myxoma [Figure 1]e, [Figure 1]f, [Figure 1]g. At 18 months' follow-up, the patient was asymptomatic and doing well.
Figure 1: (a) Transthoracic echocardiographic subcostal view showing large mass in the right atrium (asterisk) during systole attached to the interatrial septum. (b) Right atrial mass prolapsing into the right ventricle. (c) Coronary angiogram showing normal right coronary artery giving blood supply to the tumor at the interatrial septum with tumor blush noted. (d) Cineangiogram with injection at the inferior vena cava-right atrium junction showing large mass mostly in the right atrium. (e) Low magnification histopathological image showing small clusters of cells present in an abundant myxoid background stroma. The tumor is covered with fibrin (original magnification, H and E ×100). (f) Small clusters of myxoma cells (H and E ×200). (g) Tumor cells have abundant eosinophilic cytoplasm, indistinct cell borders, and oval nucleus (H and E ×400). H and E: Hematoxylin and Eosin stain

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Video 1: Echocardiogram with subcostal window showing a large mass in the right atrium attached to interatrial septum and prolapsing into the right ventricle during diastole with each beat.

[Additional file 1]

Video 2: Coronary angiogram showing normal right coronary artery giving blood supply to the tumor at the interatrial septum. Note made of tumor blush and the emptying of the vessels into right atrial cavity.

[Additional file 2]

Video 3: Cineangiogram with injection at the inferior vena cava- right atrial (RA) junction showing a large mass seen prolapsing in to the right ventricle from RA across tricuspid valve during diastole with each beat. RA: Right atrium.

[Additional file 3]

Primary cardiac tumors are rare, and most of them are benign. Myxoma is the most common among them. Myxomas usually arise in the left atrium and rarely from RA (15%–20% of the cases), ventricle, or superior vena cava.[1] They are usually solitary, polypoid, pedunculated, and are highly vascular tumors. Symptoms due to right sided myxomas can occur due to obstruction of the tricuspid valve inflow and include pedal edema, icterus, anorexia, fatigue, abdominal distention, or pulmonary embolism. Transthoracic and transesophageal echocardiography have high sensitivity in identifying these tumors.[2] Advanced imaging such as three-dimensional echocardiography, computed tomography, or cardiac magnetic resonance imaging may be required in some. Angiocardiography is rarely required these days due to the advances in noninvasive imaging. Although theoretically, angiocardiography is associated with the risk of embolic complications, most of the previous series reported no such complications.[3] We have also demonstrated the highly vascular nature of these tumors (as dilated branches of the coronary vessels supplying the tumor with associated tumor blush). Other diagnostic possibilities of increased vascularity include organized thrombi, cavernous hemangioma, and venous malformations.

Ethical clearance and informed consent

Human rights statements and informed consent: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions. Informed consent was obtained from all patients for being included in the study.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Markel ML, Waller BF, Armstrong WF. Cardiac myxoma. A review. Medicine (Baltimore) 1987;66:114-25.  Back to cited text no. 1
    
2.
Pérez de Isla L, de Castro R, Zamorano JL, Almería C, Moreno R, Moreno M, et al. Diagnosis and treatment of cardiac myxomas by transesophageal echocardiography. Am J Cardiol 2002;90:1419-21.  Back to cited text no. 2
    
3.
Attar S, Lee YC, Singleton R, Scherlis L, David R, McLaughlin JS. Cardiac myxoma. Ann Thorac Surg 1980;29:397-405.  Back to cited text no. 3
    


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