Multimodality Imaging in the Diagnosis of Coexisting Left Atrial Myxoma and Aortic Valve Papillary Fibroelastoma

Abstract

W e present the case of a 77-year-old Cambodian woman with a 3-day history of dyspnea on exertion. Physical examination revealed a murmur of mitral regurgitation and decompensated heart failure. The ECG was remarkable for atrial fibrillation with rapid ventricular response. Transthoracic echocardiography showed severe left atrial dilation, a large (5ϫ8 cm) mobile mass attached to the anterior left atrial wall, and several small, mobile aortic masses on the noncoronary cusp of the aortic valve ( Figure 1 and online-only Data Supplement Movie I).Three-dimensional transesophageal echocardiography showed a large multilobular mass being displaced by the central jet of moderate to severe mitral regurgitation during systole and prolapse of the mass through the mitral valve during diastole (Figures 2 and 3 and online-only Data Supplement Movies II and III). The atrial mass was attached with a stalk to the anterior atrial wall and appeared lobulated and deformable, consistent with the appearance of a myxoma (online-only Data Supplement Movie IV). The aortic valve masses had multiple frondlike projections, which had an appearance like a sea anemone, with stippling at the edges that arose from the noncoronary aortic valve leaflet (online-

Rapidly Growing Cardiac Papillary Fibroelastoma in a Teenager with Sickle Cell Disease

“…Interestingly, there is evidence suggesting possible links between papillary fibroelastoma and myxomas. These tumors have been reported to coexist with the heart . Moreover, myxomatous foci have been identified within papillary fibroelastomas and conversely elastic material has been observed in atrial myxomas.…”

“…These tumors have been reported to coexist with the heart. 10 Moreover, myxomatous foci have been identified within papillary fibroelastomas and conversely elastic material has been observed in atrial myxomas. It is possible these two tumors share a common histogenetic origin.…”

“…Moreover, myxomatous foci have been identified within papillary fibroelastomas and conversely elastic material has been observed in atrial myxomas. It is possible these two tumors share a common histogenetic origin . Lastly, thrombus formations commonly organize within atria and ventricles; these structures are echo dense and relatively fixed.…”

“…It is possible these two tumors share a common histogenetic origin. 10 Lastly, thrombus formations commonly organize within atria and ventricles; these structures are echo dense and relatively fixed. Vegetations usually tend to be amorphous with shaggy borders.…”

Evaluation of valvular disease by cardiac computed tomography assessment

“…41 Moreover, it appears that even with small and mobile papillary fibroelastomas, visualization is possible with MDCT. [41][42][43] Although echocardiography may still be a first-line diagnostic tool, MDCT can be an important adjunct imaging tool in evaluating valvular and cardiac tumors, with its ability to visualize the extent of tumor infiltration to optimize surgical resection strategies ( Fig. 9; Supplemental Movie 3).…”