PMC8192690_01
Transthoracic echocardiography preoperatively showing a giant biatrial mass with the size of 44.06 mm x 109.44 mm in the right atrium (A) and 17.85 mm x 23.87 mm in the left atrium (B); Color Doppler flow imaging showing severe mechanical hemodynamic obstacles in the right atrium primarily occupied by the giant tumor tissue (C).
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F1
T-waves. Transthoracic echocardiography demonstrated a giant biatrial mass with 44.06 mm x 109.44 mm in the right atrium (Figure 1A) and 17.85 mm x 23.87 mm in the left atrium (Figure 1B). Notably, the blood flowed through the tumor tissue's space with severe mechanical hemodynamic obstacles (Figure 1C).
Cardiac CT showing a biatrial mass with the atrial septum infiltrated (A); Abdominal CT showing an angiomatous mass in the right posterior lobe of the liver (arrow) (transverse view) (B), coronal (C), and sagittal (D) plane; cardiac MRI showing a giant biatrial mass with tricuspid valve involved (E); PET-CT showing a giant mass with increased glucose metabolism in the right atrium (F).
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F2
Thoracic and abdominal computer tomography (CT) showed a biatrial mass (Figure 2A) and an angiomatous mass in the right posterior lobe of the liver (Figures 2B-D, arrows). The tumor was unevenly enhanced on a contrast scan, suggesting a high possibility of a malignant tumor (Figure 2E). The possibility of a malignant tumor of mesenchymal origin was considered, given the MRI and CT scan results combined with an enhanced PET-CT scan (a giant soft tissue-like mass with increased glucose metabolism in the right atrium) (Figure 2F).
Intraoperative view of the tumor: right atrium was enlarged (A) with the tumor inside the chamber; The right side of the tumor was visualized with the opening of the right atrium (B); the biatrial mass together with the infiltrated septum was resected (C,D); the right atrial lesion was grossly composed of two parts (D, arrows).
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F3
A standard median sternotomy incision was performed, and on opening the pericardium, a massive right atrium was visualized (Figure 3A). Following the right atrium's opening, a careful exploration of the abnormalities was completed (Figure 3B). Together with the involved septum, the biatrial tumor was removed (Figures 3C,D). The resected mass from the right atrium was grossly composed of two parts; a cutaneous soft tissue-like mass and a peanut-shell shape-like mass (Figure 3D, arrows).
Immunohistochemistry post-operatively confirm the diagnosis of the cardiac myxoma with interstitial fibrous hyperplasia (A), hemorrhage (B), necrosis, and plasmacytes infiltrate.
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F4
Pathology results confirmed the primary diagnosis of cardiac myxoma and showed interstitial fibrous hyperplasia with vitrification and calcification, hemorrhage, necrosis, and plasmacytes infiltrates (Figures 4A,B).