PMC6501262_01
Computed tomography pulmonary angiogram revealed bilateral pulmonary emboli (green arrows).
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In the work-up process, he was found to have no deep venous thrombosis (DVT), but computed tomography pulmonary angiogram (CTPA) showed large pulmonary embolism more on the left side (Figures 1 and 2).
Computed tomography pulmonary angiogram revealed a broad-based filling defect in the right ventricle (green arrow), with incidental finding of preoperative raised right hemidiaphragm.
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In the work-up process, he was found to have no deep venous thrombosis (DVT), but computed tomography pulmonary angiogram (CTPA) showed large pulmonary embolism more on the left side (Figures 1 and 2). Transthoracic and transesophageal echo confirmed right ventricular filling defect (Figure 2), which initially was thought to be a right ventricular thrombus and was placed on intravenous heparin therapy.
Coronary angiogram revealed no evidence of coronary artery disease, right coronary artery fistula, or tumour blush demonstrating blood supply to the base of tumour in the ventricular septum.
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An angiogram revealed incidental distal right coronary artery fistula (Figure 3), without haemodynamic compromise, likely also represents "tumour blush." During surgery on cardiopulmonary bypass (CPB), a myxoma arising from the right ventricular septum beneath the septal leaflet of the tricuspid valve, approximately 5 cm x 4 cm in size was identified (Figure 4) and removed without spilling and further fragmentation (Figure 5).
Intraoperative photograph of histologically proven large 5 cm x 4 cm right ventricular myxoma beneath the septal leaflet of the tricuspid valve. Area where part of myxoma have fragmented and embolized (arrowhead).
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An angiogram revealed incidental distal right coronary artery fistula (Figure 3), without haemodynamic compromise, likely also represents "tumour blush." During surgery on cardiopulmonary bypass (CPB), a myxoma arising from the right ventricular septum beneath the septal leaflet of the tricuspid valve, approximately 5 cm x 4 cm in size was identified (Figure 4) and removed without spilling and further fragmentation (Figure 5).
Pathology specimen of large 55 mm x 30 mm x 30 mm smooth right ventricular myxoma with attachment site to ventricular septum (star), part of myxoma that fragmented and embolized (asterisk), blood clot removed (arrowhead), and myxoma accessories (arrow).
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An angiogram revealed incidental distal right coronary artery fistula (Figure 3), without haemodynamic compromise, likely also represents "tumour blush." During surgery on cardiopulmonary bypass (CPB), a myxoma arising from the right ventricular septum beneath the septal leaflet of the tricuspid valve, approximately 5 cm x 4 cm in size was identified (Figure 4) and removed without spilling and further fragmentation (Figure 5).
Right ventricular myxoma being excised and shaved off from ventricular septum. Note the origin of tumour beneath the septal and anterior leaflets of the tricuspid valve.
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The tumour was shaved from the septum without creating any ventricular septal defect (VSD) and protecting the tricuspid valve leaflets (Figure 6).
Histology of ventricular myxoma.
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Histology of tumour and emboli both confirmed to be myxomatous in origin (Figure 7).