* Corresponding author:
Dr. Bhupinder Singh,
Dayanand Medical College and Hospital, Udham Singh Nagar, Ludhiana
560069, India.
Tel.: +918427821837, Email:
dr_bhupinders@yahoo.in
Fax number: none
Short Title: Prolapsing right atrial myxoma
Disclosures: The authors have no financial interests or
conflict of interest regarding the content.
Data Availability Statement: The data that support the findings
of this study are available in the supplementary material of this
article.
Word count: 220
Abstract: A 22-year male presented with complaints of dyspnea.
Multimodality imaging revealed a polypoidal right atrial mass with
sub-massive pulmonary embolism. The patient underwent urgent surgery.
The pathological examination confirmed it as cardiac myxoma. Cardiac
myxoma, a most common primary cardiac tumor, is commonly found in the
left atrium. The right atrium is an uncommon site and the usual mode of
presentation is the tumor or thrombus embolisation to the pulmonary
circulation.
A 22-year previously healthy male presented with complaints of
progressive dyspnea of 1-week duration. On examination, he had
tachypneic, tachycardia, and peripheral oxygen desaturation. 12-lead
electrocardiogram showed sinus tachycardia, complete right bundle branch
block, and S1Q3T3 pattern. Chest roentgenogram showed wedge-shaped
opacity in the right upper-middle zone. Transthoracic echocardiogram
(panel A, video) revealed dilated right-sided chambers, and a large,
polypoidal, right atrial mass (RA; measuring 6.0x3.1cm) prolapsing into
the right ventricle with each cardiac cycle. Contrast-enhanced
computerised tomography of thorax confirmed the presence of RA mass
attached to the posterior wall of RA, and filling defects in MPA (panel
B) extending to the right and left pulmonary arteries (right
> left). The patient underwent urgent surgical excision
(video) of RA mass and pulmonary embolectomy. The pathological
examination (panel C, D) confirmed cardiac myxoma. The patient is doing
well at 12-months of follow-up with no recurrence.
Cardiac myxoma is the most common primary tumor of the heart. The left
atrium is the most common site for cardiac myxoma while 15-20% of cases
originate in RA.1 The clinical presentations depend on
the site, size, mobility, and friability of the cardiac
mass.2 Cardio-embolic events occur in around 30-40%
of the cases.2 The RA myxoma complicated with
pulmonary embolism is usually due to tumor embolisation, although
thrombotic embolisation has also been reported less
frequently.3