PMC8810647_01
2D echocardiography shows an irregular hyper-echoic mass in the left atrium (A) and a hypoechoic mass in the right ventricular outflow tract (B). Enhanced chest CT confirms the LA mass (C) and right ventricular mass (D). CT Pulmonary arteriography confirms that the nodules on regular CT are pulmonary emboli [(E), red arrows].
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F1
Transthoracic echocardiography revealed a large (62 mm x 28 mm), pedunculated, and highly mobile hyperechoic mass in the LA (Figure 1A; Supplementary Video 1) attached to the middle interatrial septum. The mass crossed the mitral valve into the left ventricle during diastole and returned to the LA during systole. Additionally, another hypo-echodensity was detected, although nearly missed in the right ventricular (RV) outflow tract (Figure 1B, Supplementary Video 2). Both masses in the LA and the RV were confirmed by an enhanced cardiac CT (Figures 1C,D). HU, close to the water's density, while the RV myxoma has a CT value of about 93.5 HU, higher than the soft tissue. However, chest CT upon admission (performed in accordance with the admission policy during COVID-19 pandemic) showed multiple nodules in the left lower pulmonary lobe, which were confirmed to be pulmonary artery emboli by a CT pulmonary angiography (Figure 1E).
Gross finding of right ventricular mass (A), which is nipple-shaped, jelly-like, and pedunculated, similar to the mass in the LA. Histopathological examination confirmed the LA mass (B), right ventricular mass (C), and left pulmonary mass (D) to be rich in myxomatous cells.
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F2
Additionally, another hypo-echodensity was detected, although nearly missed in the right ventricular (RV) outflow tract (Figure 1B, Supplementary Video 2). Both LA and RV (Figure 2A) masses were similar in appearance which appeared to be nipple-shaped and jelly-like with stalks. Pathologic investigation confirmed that tissues from the LA (Figure 2B), RV (Figure 2C), and pulmonary artery (Figure 2D) were all rich in myxomatous cells.