PMC2698972_01
Embolism of a left atrial cardiac myxoma a Echocardiography. Four-chamber image from ECG-gated line-balanced fast field echo pulse sequence showed an intra-atrial mass (arrow) with attachment to the inter-atrial septum. LA left atrial cavity, LV left ventricular cavity, RA right atrial cavity, RV right ventricular cavity b MRI angiography of the aortic and large lower extremity vessels. MRI perfusion image shows a circumscribed perfusion defect at the aortic bifurcation with subocclusive stenosis of the right-sided A. iliaca communis. This area revealed a bright signal enhancement on T1-weighted inversion recovery images obtained after intravenous injection of gadobutrol. c Histopathology. At thoracic surgery the left atrial mass was 6 x 4 x 3 cm in diameter. Histopathological examination of the resected tumor revealed a benign myxoma with characteristic myxoid stromal tissue containing a low number of tumor cells with uniform small nuclei and focal accumulation of siderophages. Tumor cells did not exhibit any signs of atypia (H&E, x100)
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Fig1
After emergent fasciotomy, transthoracic echocardiography performed due to hemodynamic instability demonstrated a left atrial inhomogenous mass (Fig. 1a). Furthermore, MRI angiography initiated due to signs of lower extremity vascular occlusion revealed a circumscribed perfusion defect at the aortic bifurcation (Fig. 1b). Surgical removal of the atrial mass and its aortic embolus was immediately performed and histopathology revealed a typical cardiac myxoma (Fig. 1c).