PMC9947778_01
Transthoracic echocardiogram of the left mass. A large hypoechoic mass (white arrow) was revealed in the left atrium attaching to the lateral atrial wall via a broad base.
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F1
Her electrocardiogram was normal (heart rate, 76 bpm); however, transthoracic echocardiography revealed an irregularly shaped 4.8 x 6.7 mm hypoechoic mass in the left atrium that appeared broadly based and originating from the lateral atrial wall (Figure 1).
The mass showed heterogeneous enhancement at the arterial phase (A) white arrow and the contrast uptake decreased with a longer delay time (B) white arrow.
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F2
CT images showed that the lobulated mass with homogeneous hypodensity almost occupied the left atrium and the left atrial appendage, extending to the orifice of the left superior pulmonary vein, and showing significantly inhomogeneous enhancement in the arterial phase. Contrast uptake decreased with a longer delay time (almost into the portal venous phase) (Figure 2).
Characterization of the left atrial mass on cardiovascular magnetic resonance imaging. A slice of a short-axis view of left atrium was acquired on native T1 mapping (A), T2 mapping (B), and cine imaging (C), respectively. The mass was heterogeneous on native T1 mapping and T2 mapping. The native T1 value ranged from 1,661 to 2,109 ms. The T2 value was also significantly elevated.
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F3
Regarding CMR imaging, compared with the myocardium, the lesion showed significantly elevated native T1 and T2 values on T1 and T2 mapping (Figure 3).
Left atrial mass on late gadolinium-enhanced (LGE) imaging. Significant patchy enhancement (white arrows) was observed on LGE images. (A) 4-chamber view; (B) a shot-axis view of left atrium.
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F4
Mildly increased regional perfusion was observed in the mass during first-pass perfusion imaging, as well as heterogeneous enhancement on late gadolinium-enhanced (LGE) imaging (Figure 4).
Histopathological features of the left atrial mass. Hematoxylin-eosin (HE) stained section showed that tumors cells were spindle-shaped, prominent atypical. Mitotic activity was frequent. Myxoid changes could be observed in stroma. [Bars: (A) 200 mum; (B) 100 mum].
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F5
Some stromal myxoid changes could also be observed in the tumor (Figure 5).