Rapidly growing cardiac myxoma diagnosed within 1 year after unremarkable prior cardiac imaging

Abstract

Primary cardiac tumors are very rare entities, atrial myxomas being the most common type. However, with increased imaging examinations and the use of high‐resolution technologies, incidentally discovered tumors and smaller lesions become more and more frequent. Here we report the diagnostic evaluation and successful surgical resection of such a cardiac myxoma in 65‐year‐old Caucasian males that developed and became symptomatic within 1 year. Notably, computed tomography and echocardiography performed 1 year before could not detect the tumor, even after critical retrospective evaluation. Primary cardiac tumors are rare entities, atrial myxomas being the most common type. However, with increased imaging examinations and the use of high‐resolution technologies, incidentally discovered tumors and smaller lesions become more frequent. Here we describe the diagnostic evaluation and successful surgical resection of a cardiac myxoma that developed and became symptomatic within 1 year after unremarkable prior imaging. Notably, computed tomography (Figure 1A) and echocardiography performed 1 year before could not detect the tumor, even after critical retrospective evaluation. A 65‐year‐old Caucasian male with symptoms of heart failure (NYHA Class III) for 2 months and recurring atrial fibrillation was referred to our hospital for further diagnostic evaluation. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) revealed a suspicious mass within the left atrium (LA) attached to the anterior wall with moderately impaired left ventricular ejection fraction of 35%. Subsequently, cardiac computed tomography (CT) verified the described tumor mass (diameter 12mm × 17mm× 17mm) (Figure 1B). The patient was taken to the operating theater, where a median sternotomy was performed and cardiopulmonary bypass was installed through aorto‐right atrium cannulation. After opening of the LA, the sessile mass was successfully excised. The resulting defect in the septum was then directly closed. The patient was easily weaned from cardiopulmonary bypass. She made an uneventful recovery, extubated on the second postoperative day, and transferred to intermediate care on day 4. Before leaving the hospital, the TTE showed a moderate impairment of ventricular function, well‐ functioning heart valves, no intracardiac masses, and no pericardial effusions. Histological examination of the excised tumor confirmed the diagnosis of atrial myxoma (Figure 1C,D). Clinical symptoms of cardiac tumors could be absent or nonspecific, resulting in delayed diagnosis and treatment. The radiological evaluation of these neoplasms has been greatly facilitated by the development of noninvasive cardiac imaging, that is, TTE and TEE, CT and magnetic resonance tomography (MRT). Nevertheless, there are only very few case reports in the literature describing the growth rate of these tumors, mostly in infants or in the elderly. The first report on this topic appeared in 1983. In most reports, there was no clearly defined starting point, so that the exact growth speed of the tumor cannot be reliably assessed. The current report demonstrates the necessity to include cardiac tumors in the differential diagnosis of newly appearing lesions even after unremarkable recent cardiac imaging and to differentiate them from reactive or thrombotic lesions.