Cardiac myxoma: a contemporary multimodality imaging review

Abstract

Cardiac myxoma (CM) is by far the most common primary benign cardiac tumor, typically arising in the left atrium with an attachment point in the fossa ovalis region. Although the etiology of CM remains unclear, we know that this endocardial-based mass originates from undifferentiated mesenchymal cells. Continuous technical improvements in the field of echocardiography since the 1960s has profoundly changed the diagnostic approach by allowing a good tumor detection as well as the preoperative planning by providing crucial information concerning the attachment point location. However, echocardiography has its limitations among which lack of tissue characterization and restricted field of view can arise diagnosis difficulties in atypical presentations. With the widespread and routine use of echocardiography and chest computed tomography (CT), incidental detection of CM is not infrequent. As a consequence, it has become mandatory for cardiologists and radiologists evolving in a multimodality imaging world to be familiar with the wide range of presentations of this tumor. The authors present here a review of the common and less common aspects of CM using the main imaging modalities available: echocardiography, cardiovascular magnetic resonance imaging, CT, positron emission tomography and coronary angiography.

Comparison of Clinical and Echocardiographic Characteristics between Cardiac Myxomas and Masses Mimicking Myxoma

“… 6) 7) Cardiac myxomas have been well known as the most frequent primary benign cardiac tumors in adults accounting for 50–85% of them. 2) 7) TTE is a widely available, noninvasive diagnostic method for initial evaluation of cardiac myxomas. In recent years, various imaging studies including TTE are conducted for health screening.…”

“… 13) 14) 15) 16) LA is the well-known, most prevalent site of myxomas with the incidence of 77–95% in recent studies, 8) 9) 10) 17) 18) and 80% of which are attached to the interatrial septum ( Table 5 ). 2) Tumors other than myxomas found in the LA cavity might be confused with myxomas and myxomas involving the sites other than the LA may be mistaken for other tumors. Garatti et al 18) reported that among 102 patients with preoperative diagnosis of myxomas, 4 patients (3.9%) with LA tumors were confuted by pathology after surgery, 3 of which were found to be thrombus and one was primary cardiac sarcoma.…”

“…Cardiac myxoma is the most frequent benign cardiac tumor which accounts for about 50% to 80% of primary cardiac tumors. 1) 2) Although it can cause valvular heart disease-like heart failure, constitutional symptoms and embolic complications, the diagnosis is often challenging because of its heterogeneous clinical features. These clinical manifestations depend on characteristics of the tumors including size, location, mobility and the surface.…”

Recurrence of left atrial myxoma mimicking a mitral annuloplasty ring thrombosis

“…Large, thin, and hypermobile forms are unusual . The frequency of recurrence is about 22% for complex forms and 12% for other familial forms and 1% to 3% for sporadic myxomas, which seldom recur after surgery . Although, 2D and RT‐3D TEE show usually accurate imaging capabilities to detect the myxoma, further imaging methods including computed tomography, cardiovascular magnetic resonance imaging, and 18 F‐fluorodeoxyglucose positron‐emission tomography/computed tomography may be useful for diagnosis .…”

A Comprehensive Perspective of Clinical and Echocardiographic Features in the Differential Diagnosis of Cardiac Myxomas and Myxoma-Like Masses

“…CMs are usually solitary and are attached to the interatrial septum (IAS) at the border of the fossa ovalis, usually protruding into the left atrium (LA) but occasionally into the right atrium (RA) and rarely into the ventricles. 3) 5) The mobility of the tumor depends upon the extent of attachment to the IAS and the length of the stalk. CMs vary in size from 1–15 cm (mean 3–4 cm) in diameter.…”