PMC6469271_01
Computed tomography (CT) scan of the chest with contrast. CT scan of the
chest done using pulmonary embolism (PE) protocol that demonstrates
extensive PE extending throughout the entire right pulmonary artery with
sparing of the left pulmonary artery, seen in (a) axial, (b) coronal, and
(c) sagittal views. Panel (c) also demonstrates the right atrial myxoma,
which was identified as the source of the PE.
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CT angiogram chest showed a large embolus in the distal main right pulmonary artery straddling the right upper and lower lobe pulmonary artery divisions; almost completely occluding flow to the segmental arteries (Figure 1).
Atrial myxoma on multi-modality imaging. (a) Transthoracic echocardiogram
(TTE) (RA/RV view) showing mobile echo dense right atrial mass, tethered to
the inter-atrial septum, consistent with right-sided atrial myxoma. (b) TTE
xPlane of subcostal view depicting right atrial myxoma and origination from
inter-atrial septum. (c) TTE with 3D reconstruction of right atrial myxoma
seen through the tricuspid valve. (d) Right atrial myxoma with stalk
tethered to inter-atrial septum on CT chest with contrast, also
demonstrating complete opacification of right pulmonary artery with embolic
myxoma.
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Transthoracic echocardiogram (TTE) showed a large, highly mobile mass attached to the right inter-atrial septum (Figure 2) prolapsing through the tricuspid valve in diastole highly suggestive of a cardiac myxoma (Supplemental Video 1).
(a) Atrial myxoma present in the right atrium. An intraoperative photograph
of median sternotomy and right atrial mass resection with cardiac myxoma
visible within the right atrium (centered in image). (b) Three papillary
yellow and red soft tissue fragments from the right atrium, measuring
2.9 x 2.3 x 2.1 cm in aggregate.
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The patient underwent median sternotomy, right atrial mass resection, repair of atrial septal defect with pericardium, and pulmonary embolectomy (Figure 3).