The Differentiation of Giant Right Atrial Myxoma from Metastatic Cancer with the Use of Multiple Imaging Modalities

Abstract

Whether a cardiac tumor is primary or metastatic strongly influences the therapeutic strategy. We herein present a case of a cardiac tumor that occupied most of the right atrium which required immediate treatment in a patient with breast cancer. Multiple imaging modalities, especially computed tomography and cardiac magnetic resonance imaging, provided a precise preoperative diagnosis. We performed cardiac surgery prior to breast cancer surgery because the cardiac tumor was thought to be a myxoma rather than a metastatic cancer.

Treatment of recurrent isolated right atrial metastatic cavitary mass from breast cancer with radiation therapy: A case report and review of literature

“…Although the majority of cases of cardiac metastases are asymptomatic and thus diagnosed at autopsy, patients may have various clinical presentations depending on the anatomic cardiac compartment involved as well as the tumor burden. Patients may present with chest pain, dyspnea, palpitations, arrhythmias, conduction abnormalities, pericardial effusion, tamponade, cardiogenic shock, or even sudden death …”

“…Differential diagnosis of the mass includes primary tumor, secondary tumor, thrombus, or even a vegetation. Thus, making the right diagnosis is of paramount importance as the management plan is entirely different based on the diagnosis …”

“…Patients may present with chest pain, dyspnea, palpitations, arrhythmias, conduction abnormalities, pericardial effusion, tamponade, cardiogenic shock, or even sudden death. [1][2][3][4][5][6] Approach to a solitary cardiac cavitary mass in a patient with the history of cancer is challenging. Differential diagnosis of the mass includes primary tumor, secondary tumor, thrombus, or even a vegetation.…”

“…Thus, making the right diagnosis is of paramount importance as the management plan is entirely different based on the diagnosis. [3][4][5][6][7][8][9][10] Although the definitive diagnosis is made by biopsy, multimodality imaging techniques, including echocardiography, computed tomography (CT), magnetic resonance imaging (MRI), and Fluorodeoxy-glucose (FDG) PET, are useful and widely used diagnostic tools. 5-10 Furthermore, the characteristic features of the lesions in some cases in the setting of history of malignancy may favor a metastatic process, precluding the need for biopsy for diagnostic purposes.…”

Upper vena cava syndrome secondary to giant atrial myxoma

“…Tricuspid valve stenosis causes systemic venous congestion without pulmonary congestion while pulmonary embolism produces dyspnoea and pulmonary hypertension causing right heart failure. 8 We did not find in the literature a similar report caused by myxoma. We believe that due to the mobility of the tumour, such manifestation usually does not occur since the obstruction to the flow would be intermittent.…”