|Ahead of print publication
Angiocardiographic Demonstration of Right Atrial Myxoma
Prashant Panda1, Krishna Prasad1, Vivek Jaswal2, Kirti Gupta3, CR Pruthvi1, Krishna Santosh1, Dinakar Bootla1, Yash Paul Sharma1
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 Submission||12-Nov-2020|
|Date of Acceptance||01-Feb-2021|
|Date of Web Publication||08-Apr-2021|
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|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 [Epub ahead of print] [cited 2021 Jul 23]. Available from: https://www.jiaecho.org/preprintarticle.asp?id=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. 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. 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. 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
Conflicts of interest
There are no conflicts of interest.
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