Image in medicine
Atrial myxoma
Mixoma auricular
Ana Isabel Ferreiraa,1,
, Sofia Torresb,1, José Máximoc, João Vilaçad, Gonçalo Pestanab, Filipe Macedob
Corresponding author
a Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
b Department of Cardiology, Centro Hospitalar Universitário de São João, Portugal
c Department of Cardiac Surgery, Centro Hospitalar Universitário de São João, Portugal
d Department of Intensive Care, Centro Hospitalar Universitário de São João, Portugal
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She reported worsening exertional dyspnea for a month. Blood analysis revealed hypoxemic respiratory acidosis and an elevated brain natriuretic peptide. The patient was placed on noninvasive-ventilation and started intravenous furosemide. Electrocardiogram showed sinus rhythm. Chest X-ray displayed bilateral pulmonary congestion. Transthoracic echocardiogram (figure 1, videos) in the apical four-chamber (panel A) and short-axis views (panel B) revealed a mobile, heterogeneous and vacuolated mass attached to the interatrial septum by a pedicle, prolapsing into the left ventricle during diastole causing mitral valve inflow obstruction visible in continuous wave Doppler (panel C), with a mean transmitral gradient of 17<span class="elsevierStyleHsp" style=""></span>mmHg. Both ventricles had normal systolic function. The patient was admitted to the cardiac care unit and had a favourable evolution, with early suspension of noninvasive-ventilation. Coronary angiography showed absence of atherosclerotic lesions. On day two, she underwent surgical excision of the mass measuring 45<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>37<span class="elsevierStyleHsp" style=""></span>mm (panel D), interatrial septum resection and reconstruction with a bovine pericardial patch. Histologic examination confirmed the suspicion of an atrial myxoma. The patient remains asymptomatic after 2 years of follow-up (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">This case highlights the importance of rapidly performing a transthoracic echocardiogram in patients with pulmonary oedema and no cardiac disease.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patient consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patient consent for the publication of the image in medicine was obtained.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case description" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient consent" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Both authors contributed equally.</p>" "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0035" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:4 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 265 "Ancho" => 1405 "Tamanyo" => 56344 ] ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 3459800 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 2 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 1119094 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 3 => array:5 [ "identificador" => "upi0015" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 1119094 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015800000010/v1_202206100851/S2387020622002054/v1_202206100851/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015800000010/v1_202206100851/S2387020622002054/v1_202206100851/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622002054?idApp=UINPBA00004N" ]
