Keywords:
Cardiac Surgical Procedures; Myxoma, Heart Atria/ physiopathology; Multidetector Computed Tomography
A 57-year-old woman presented to her local hospital with left arm and leg weakness and was diagnosed with a right-sided stroke. A subsequent transthoracic echocardiogram showed a large, poorly-defined mass within the left atrium, which prompted her transfer to our institute for urgent surgical resection.
As a prelude to surgery, we performed a "tripartite" coronary CT angiogram to assess the coronary anatomy and left atrial mass (Figure 1). The findings were consistent with a left atrial myxoma and the patient subsequently underwent surgery, where the mass was resected and the diagnosis substantiated (Figure 2).
ECG-gated cardiac computed tomography. Figure 1a shows a large mass (arrow) occupying one third of the left atrium in systole (40% phase). Figure 1b shows the mass (arrow) prolapsing through the mitral valve into the left ventricle in diastole (90% phase). On first pass perfusion (FPP) imaging (Figure 1c) the mass was shown to be hypoattenuated (52 HU) when compared to the myocardium (140 HU) indicating reduced vascularity. Figure 1d shows a lack of delayed enhancement (DE) on an interval scan performed 7 minutes later in keeping with the benign nature of the myxoma.
Myxomas have an estimated incidence of 0.007%. Although echocardiography remains the first-line investigation to establish their diagnosis, the current case highlights the typical appearances and usefulness of CT as a second-line investigation when further information is required.
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Sources of Funding
There were no external funding sources for this study. -
Study Association
This study is not associated with any thesis or dissertation work.
Publication Dates
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Publication in this collection
July 2015
History
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Received
09 Mar 2015 -
Reviewed
23 Mar 2015 -
Accepted
01 Apr 2015
