ACCURACY OF TRANSTHORACIC ECHOCARDIOGRAPHY IN DIAGNOSIS OF CARDIAC MYXOMA: SINGLE CENTRE EXPERIENCE

The differential diagnosis of cardiac myxomas (CM), the most common benign primary cardiac tumors, is broad and a thorough diagnostic workup is required to establish accurate diagnosis prior to surgical resection. Transthoracic echocardiography (TTE) is usually the first imaging modality used for diagnosis of suspected CM. Purpose In a single tertiary centre study, we sought to determine the accuracy, sensitivity, and specificity of TTE in the diagnosis of CM and to determine echocardiographic characteristics indicative of CM. Methods and results We retrospectively analyzed clinical, echocardiographic, and pathohistological findings of 73 patients consecutively admitted for suspected CM. After diagnostic workup, 53 (73%) patients were treated surgically at our institution. Based on preoperative TTE, patients were divided into a CM group (n=45, 85%) and non-myxoma (NM) group. Of the 53 pathohistological specimens obtained during surgery, 39 (73%) were CM. The sensitivity and specificity of preoperative echocardiography were 97% and 50%, respectively. The overall accuracy was 85%. All NM tumors were found in an atypical location and 72% of CM were found in a typical position in the left atrium (p<0.001). Tumors in NM group were significantly smaller than CM (24.3±13.2 mm vs 37.9±18.3 mm, p=0.017). Conclusion Our study confirms very good accuracy of TTE in the diagnosis of CM. The most important echocardiographic characteristics to differentiate between CM and tumors of different etiology are tumor location and size. Smaller tumors presenting at an atypical location are less likely to be diagnosed as CM, and these require additional imaging modalities for accurate diagnosis.

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Fetal Cardiac Myxomas

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/s-0043-115228 ◽

2017 ◽

Vol 221 (04) ◽

pp. 175-179 ◽

Cited By ~ 1

Author(s):

Shi-Min Yuan

Keyword(s):

Cardiac Myxoma ◽

Diagnostic Technique ◽

Tumor Location ◽

Good Prognosis ◽

Cardiac Tumors ◽

Cardiac Events ◽

Comprehensive Literature Review ◽

Adverse Cardiac Events ◽

Predictive Risk ◽

Cardiac Myxomas

AbstractFetal cardiac myxomas are very rare. To date there has been no representative description of fetal cardiac myxomas. The aim of this study is to highlight the clinical features, possible outcomes and the disparities from the adult cardiac myxomas and other fetal cardiac tumors.A comprehensive literature review yielded 27 reports including 32 cases of fetal cardiac myxomas.Apart from the same pedunculated and solitary nature and echogenic appearance, fetal cardiac myxomas differ from those in adults in many aspects, including tumor location, clinical manifestation and malignant potential. Fetal cardiac myxomas are the most common in the left ventricle and the least common in the left atrium. Tumor size and tumor site could be predictive risk factors of adverse cardiac events of fetuses.Their clinical courses are often benign with fewer cases of adverse cardiac events. Prenatal echocardiography is a reliable diagnostic technique, which can detect cardiac myxomas at as early as 18 weeks gestation. Differential diagnosis should be made from other types of fetal cardiac tumors. Postnatal cardiac myxoma resection may provide a good prognosis.

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Atypical Left Ventricular Myxoma: Unusual Echocardiographic and Histopathological Features

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117742626 ◽

2018 ◽

Vol 11 (4) ◽

pp. NP129-NP131

Author(s):

Sushil Azad ◽

Nilanjan Dutta ◽

Kuntal Roy Chowdhuri ◽

Tarun Raina Ramman ◽

Nishit Chandra ◽

...

Keyword(s):

Hydatid Cyst ◽

Histopathological Examination ◽

Cardiac Myxoma ◽

Surgical Excision ◽

Interatrial Septum ◽

Left Ventricular ◽

Cardiac Tumors ◽

Complete Surgical Excision ◽

Vascular Proliferation ◽

Cardiac Myxomas

Cardiac myxomas are the most common primary cardiac tumors and are typically attached to the interatrial septum. Left ventricular myxomas are exceedingly rare and presentation in children is all the more uncommon. We report a case of left ventricular myxoma with very atypical cystic appearance raising an initial suspicion of a hydatid cyst. Subsequently, cardiac magnetic resonance imaging was done, which ruled out the diagnosis of hydatid cyst. Complete surgical excision was done through transaortic and transmitral route. Histopathological examination revealed it to be a cardiac myxoma with vascular proliferation, which on echocardiography had appeared as a polycystic lesion. This is a very unusual histopathological presentation of cardiac myxoma.

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Thymic pathology and cardiac myxomas: Coincidence or a closer relationship?

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2018.905 ◽

2018 ◽

Vol 88 (1) ◽

Author(s):

Sotirios D. Moraitis ◽

Apostolos C. Agrafiotis ◽

Dimitrios Pappas ◽

Chrysovalantis Pothitakis ◽

Maria Stergianni ◽

...

Keyword(s):

Left Atrium ◽

Cardiac Myxoma ◽

Anterior Mediastinum ◽

Thymus Gland ◽

Thymic Hyperplasia ◽

Cardiac Tumors ◽

Cardiac Myxomas ◽

Thymic Tumors

Myxomas are the most common benign cardiac tumors and are located more frequently in the left atrium. In the literature there are cases describing the coexistence of thymic tumors and cardiac myxomas. In the case reported herein, during the resection of a cardiac myxoma, an enlarged thymus gland was encountered and resected. The histological exam revealed a thymic hyperplasia. The aim of this case study is to assess the need of conducting further studies in order to identify a common histological pathway between thymic lesions and cardiac myxomas. The diagnosis of a cardiac myxoma could justify a further workup of the anterior mediastinum in order not to overlook a lesion of thymic origin.

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Left Atrial Myxoma with Tricuspid Regurgitation: Pathophysiology, Diagnostic Approach, and Management

Indonesian Journal of Cardiology ◽

10.30701/ijc.v36i1.438 ◽

2015 ◽

pp. 28-3

Author(s):

Prima Almazini ◽

Bambang Budi Siswanto ◽

Nani Hersunarti ◽

Rarsari Soerarso ◽

Amiliana M Soesanto

Keyword(s):

Cardiac Myxoma ◽

Clinical Manifestations ◽

Definitive Treatment ◽

Surgical Removal ◽

Cardiac Tumors ◽

Gold Standard Method ◽

Left Atrial Myxoma ◽

Associated Conditions ◽

Cardiac Myxomas ◽

Primary Cardiac Tumors

Cardiac myxomas are the most common primary cardiac tumors. Myxoma are more common in women. Clinical manifestations can mimic many cardiac and noncardiac conditions. Transthoracic echocardiography (TTE) is the gold standard method in the diagnosis of cardiac myxoma. The management of cardiac myxoma are medical therapy for the treatment of associated conditions and surgical removal as the definitive treatment.

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Echocardiographic characteristics of cardiac myxoma

European Heart Journal ◽

10.1093/eurheartj/ehab724.0146 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

P Koritnik ◽

N Pavsic ◽

M Bervar ◽

K Prokselj

Keyword(s):

Left Atrium ◽

Tumor Size ◽

Cardiac Tumor ◽

Imaging Modality ◽

Cardiac Computed Tomography ◽

Cardiac Myxoma ◽

Clinical Manifestations ◽

Cardiac Tumors ◽

Number Of Patients ◽

Cardiac Masses

Abstract Background Accurate imaging differentiation of various cardiac masses is pivotal due to differences in clinical management and treatment. The most common primary cardiac tumor is cardiac myxoma (CM), which is typically located in the left atrium attached to the interatrial septum. Although benign, serious clinical manifestations may occur and surgical treatment of CM is warranted in most cases. Echocardiography is the most common imaging modality, with a reported sensitivity of 90–96%, however accurate diagnosis can be challenging due to the heterogeneous morphological presentation of CM. Purpose The aim of this study was to determine the utility of echocardiography in CM diagnosis. Methods We retrospectively analyzed the echocardiographic and pathohistological findings of all consecutive patients admitted to our cardiology department for possible CM between 2005 and 2020. Results During the 15-year period, 73 patients were admitted for diagnostic evaluation of a possible CM. Subsequently, 54 patients (74%) were diagnosed with CM or another non-myxomal (NM) cardiac tumor, while in others cardiac masses of other etiologies (thrombus, infective endocarditis, etc.) were diagnosed (Figure 1). All but one patient with CM or NM cardiac tumor were treated surgically at our institution and pathohistological specimens were obtained from the resected tumor. There was a significant female preponderance (n=34, 63%) and the mean age at the time of surgery was 64±14 years. Based on the preoperative echocardiographic findings, 45 (85%) tumors were diagnosed as CM and 8 as NM cardiac tumors (Figure 1). Evaluation of pathohistological specimens revealed CM in 39 of 53 (74%) operated patients. Patohistiologically, a NM cardiac tumor was diagnosed in 7 patients who were preoperatively classified as CM. The sensitivity and specificity of preoperative echocardiography for the detection of CM were 97% and 50%, respectively (Figure 1). The echocardiographic characteristics of pathohistologically confirmed CM were compared to cases of NM cardiac tumors. The comparison between the two groups revealed statistically significant differences in localization and tumor size. All NM cardiac tumors were located in an atypical position and 72% of CM were found in a typical position within the left atrium (p<0.001). NM cardiac tumors were also significantly smaller than CM (25.1±12.6 mm vs. 37.5±18.5 mm, p=0.029). Conclusion Our single-center study confirms the excellent sensitivity of echocardiography for CM diagnosis. The specificity of echocardiography was modest, thus caution is warranted due to a wide differential diagnosis of CM. The diagnosis of CM seems to be less likely with atypical tumor location and small tumor size. Other non-invasive imaging modalities such as cardiac computed tomography or magnetic resonance imaging should be considered in such cases. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Flow chart showing the number of patients diagnosed with CM on preoperative echocardiography.

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Left Atrial Myxoma and Antiphospholipid Syndrome—A Case Report

International Journal of Angiology ◽

10.1055/s-0041-1740103 ◽

2021 ◽

Author(s):

Mijo Meter ◽

Diana Meter ◽

Toni Ceprnja ◽

Dijana Perkovic

Keyword(s):

Case Report ◽

Antiphospholipid Syndrome ◽

Lupus Erythematosus ◽

Left Atrial ◽

Imaging Modality ◽

Cardiac Myxoma ◽

Atrial Myxoma ◽

Cardiac Tumors ◽

Left Atrial Myxoma ◽

Initial Imaging

AbstractCardiac myxoma (CM) is the most frequent type of primary cardiac neoplasm and is responsible for 58 to 80% of primary cardiac tumors. The antiphospholipid syndrome (APS) occurs most commonly in the systemic lupus erythematosus but it can be also found in other conditions. The coexistence of CM and APS is rarely described in the literature. We report an unusual case of the left atrial myxoma and concomitant APS in a female patient who presented with right-sided hemiplegia. Although rare, we must think about the CM in patients with a newly diagnosed APS and left atrial mass. Nevertheless, we must make a distinction from other possible cardiac structures, especially atrial thrombus. Transthoracic echocardiography is the most frequently used initial imaging modality to detect CM. The aim of this case report was to emphasize that additional imaging modalities and multidisciplinary approach are mandatory in making a proper diagnosis and to choose a further treatment strategy.

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Growth hormone and risk for cardiac tumors in Carney complex

Endocrine Related Cancer ◽

10.1530/erc-16-0246 ◽

2016 ◽

Vol 23 (9) ◽

pp. 739-746 ◽

Cited By ~ 5

Author(s):

W Patricia Bandettini ◽

Alexander S Karageorgiadis ◽

Ninet Sinaii ◽

Douglas R Rosing ◽

Vandana Sachdev ◽

...

Keyword(s):

Growth Hormone ◽

Cardiac Myxoma ◽

Heart Tissue ◽

Carney Complex ◽

Cardiac Tumors ◽

Gh Secretion ◽

Albright Syndrome ◽

Cardiac Myxomas ◽

Gh Excess

Carney complex (CNC) is a multiple neoplasia syndrome that is caused mostly by PRKAR1A mutations. Cardiac myxomas are the leading cause of mortality in CNC patients who, in addition, often develop growth hormone (GH) excess. We studied patients with CNC, who were observed for over a period of 20 years (1995–2015) for the development of both GH excess and cardiac myxomas. GH secretion was evaluated by standard testing; dedicated cardiovascular imaging was used to detect cardiac abnormalities. Four excised cardiac myxomas were tested for the expression of insulin-like growth factor-1 (IGF-1). A total of 99 CNC patients (97 with a PRKAR1A mutation) were included in the study with a mean age of 25.8 ± 16.6 years at presentation. Over an observed mean follow-up of 25.8 years, 60% of patients with GH excess (n = 46) developed a cardiac myxoma compared with only 36% of those without GH excess (n = 54) (P = 0.016). Overall, patients with GH excess were also more likely to have a tumor vs those with normal GH secretion (OR: 2.78, 95% CI: 1.23–6.29; P = 0.014). IGF-1 mRNA and protein were higher in CNC myxomas than in normal heart tissue. We conclude that the development of cardiac myxomas in CNC may be associated with increased GH secretion, in a manner analogous to the association between fibrous dysplasia and GH excess in McCune–Albright syndrome, a condition similar to CNC. We speculate that treatment of GH excess in patients with CNC may reduce the likelihood of cardiac myxoma formation and/or recurrence of this tumor.

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Surgical Treatment of Cardiac Myxomas: A 23-Case Experience

The Heart Surgery Forum ◽

10.1532/hsf.1987 ◽

2018 ◽

Vol 21 (5) ◽

pp. E370-E374 ◽

Cited By ~ 1

Author(s):

Ali Kemal Gür ◽

Mehmet Coşkun Aykaç

Keyword(s):

Cardiac Tumor ◽

Tumor Location ◽

Cardiac Tumors ◽

Aortic Cross Clamp ◽

Tumor Patients ◽

Common Complaint ◽

Surrounding Healthy Tissue ◽

Cardiac Myxomas ◽

The Right ◽

Operation Risk

Objective: Although seen rarely compared to all tumors, cardiac tumors are tumors which may have a mortal course with possible complications. The most common cardiac tumor in adults is myxoma with its benign character. The results of cardiac tumors resected with open cardiac surgery in our center are reported in this study. Materials and Methods: Twenty-three cardiac tumor patients electively operated on in our clinic between January 2010 and August 2017 were retrospectively included in the study. Information of the patients participating in the study were registered. The patients were between 25 and 67 years of age, and 18 were female (72.3%), and 5 were male (21.7%). The average age of the patients was 42.1 ± 8.9 years. Echocardiography was used for diagnosis in all patients. There was no common complaint for the patients, with the complaints changing according to tumor location. All patients were operated on by means of cardiopulmonary bypass with aortic cross-clamp and bicaval cannulation. Preoperative demographical characteristics and perioperative and postoperative data were registered for the patients and were evaluated statistically. Results: Nineteen of the tumors (82.6%) were in the left atrium, and 4 were (17.4%) in the right atrium. Diameter of the tumors changed between 2.5 × 1.5 and 8.5 × 6.5 cm. The tumoral structure was resected together with the solid tissue located in its root in all patients operated on. Pericardial patch was used for 11 (47.8%), and primary closure was used for 12 (51.2%) of the defects. Early and late mortality was not observed in any patient. Conclusion: To prevent possible complications of cardiac myxomas, they need to be resected together with the surrounding healthy tissue as soon as possible after the diagnosis. Cardiac myxomas can be operated on with a tolerable operation risk. Echocardiography should be made annually for any possible relapse after operation.

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Surgical Treatment of Primary Intracardiac Myxoma: 20-Year Experience in “Shahid Modarres Hospital”—A Tertiary University Hospital—Tehran, Iran

The Scientific World JOURNAL ◽

10.1155/2015/303629 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Zahra Ansari Aval ◽

Hamid Ghaderi ◽

Hassan Tatari ◽

Mahnoosh Foroughi ◽

Seyedeh Adeleh Mirjafari ◽

...

Keyword(s):

Tumor Resection ◽

Cardiac Myxoma ◽

University Hospital ◽

Cardiac Tumors ◽

Age Difference ◽

Septal Defects ◽

Functional Classes ◽

And Gender ◽

Cardiac Myxomas ◽

Mean Time

Although cardiac tumors are not common they may vary in terms of race and surgical approach in different countries.Method. Patients data of 20 years was collected and evaluated in the “Shahid Modarres Hospital”—a tertiary university hospital—Tehran, Iran.Results. 42 patients with cardiac myxoma (all cases in 20 years) were included in study, 17 males and 25 females, age difference: 13 to 76 years (mean 50.6). Most of patients were in functional classes I, II. 35 patients complained of dyspnea and 3 patients had embolic events. 97.6% of tumors were primary (41 patients) and one tumor was recurrent (2.4%), 85.7% of tumors (36 cases) were located in LA, and 88.1% of tumors (37 cases) were pediculated. 40 patients (95%) had one tumor. In 22 patients (52.3%) after tumor resection septal defects were repaired primarily while in 18 patients (42.8%) the defects were repaired with pericardial patch and In one patient, tumor resected without any septal defect. Mean tumor size was about 5.22 cm (range of 2.2 to 8.2 cm). Postoperatively, 33 patients discharged from hospital without any complication.Discussion. The research reveals that patients’ age and gender were similar to that of other studies in other countries while tumor’s incidence seems to be higher. 3 patients were diagnosed after remote embolic event and one patient was diagnosed after MI reflecting relatively high tumor complications and late diagnosis.Conclusion. In our study mean time from diagnosis to operation was too long. The patients had more preoperative embolic events and complication. However, size of myxoma and location of that was as same as its rate in the other literature. As recommendation we suggested that in all patients with vague chest pain or remote embolic events cardiac myxomas should be ruled out.

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Rare Case of 6 cm Right Atrial Myxoma in Patient with Synchronous Endometrial Adenocarcinoma

Case Reports in Cardiology ◽

10.1155/2021/4657117 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Mohammad Altujjar ◽

Feras Zaeim ◽

Erin Sheehan ◽

Wily Gan ◽

Mohammed Mhanna ◽

...

Keyword(s):

Rare Case ◽

Endometrial Adenocarcinoma ◽

Cardiac Myxoma ◽

Atrial Myxoma ◽

Right Atrial ◽

Cardiac Tumors ◽

Right Atrial Mass ◽

Right Atrial Myxoma ◽

Cardiac Myxomas ◽

Primary Cardiac Tumors

Primary cardiac tumors are extremely rare. Cardiac myxomas most frequently appear in the left atrium. In this article, we present a case of an asymptomatic 6 cm right atrial mass in a patient undergoing staging for endometrial cancer. The mass was resected, and final pathology was consistent with cardiac myxoma.

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