PMC6188732_01
(a) Transthoracic echocardiogram with right ventricular myxoma (arrow). (b) Transthoracic echocardiogram with agitated saline revealing a right ventricular myxoma measuring 2.78 cm x 1.8 cm.
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Subsequently, a transthoracic echocardiogram was performed and revealed a mass in the right ventricle attached to the posterior wall and prolapsing into the right ventricular outflow tract (RVOT) in systole (Figure 1).
(a) RV myxoma on TEE (arrow). (b) Color flow around RV myoxoma on TEE.
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Next, a transesophageal echocardiogram was performed to better characterize the mass, which measured 2.6 cm x 4.1 cm and was mobile and prolapsed into the RVOT during systole resulting in a mild dynamic obstruction (Figure 2(a)). Color Doppler revealed turbulent flow in the RVOT and pressure gradient measurements revealed a gradient of 26 mmHg across the RVOT while the patient was heavily sedated and in a supine position (Figure 2(b)).
RV mass appreciated on cardiac catheterization.
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The patient was referred to cardiothoracic surgery for further evaluation and underwent a cardiac catheterization prior to thoracotomy which also showed evidence of a RV mass (Figure 3).
RV myxoma excised.
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A thoracotomy with excision of the mass was performed (Figure 4), and pathological examination revealed the mass as a myxoma (Figure 5).
The tumor is comprised of spindled or stellate cells with eosinophilic cytoplasm and uniform, round nuclei with inconspicuous nucleoli in a background of myxoid stroma. Chronic inflammatory cells including hemosiderin-laden macrophages are also present. The cellularity is variable; however, no foci of increased cellularity marked nuclear pleomorphism or increased mitotic activity seen.
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A thoracotomy with excision of the mass was performed (Figure 4), and pathological examination revealed the mass as a myxoma (Figure 5).
(a) Subcostal view on transthoracic echocardiogram two years postprocedure without evidence of recurrence of RV myxoma. (b) Apical view from the same study (arrow: right ventricle).
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Repeat echocardiogram two years postresection did not reveal any evidence of recurrence of the myxoma (Figures 6(a) and 6(b)).