A 78-year-old woman with type 2 diabetes, hyperlipidemia, and hypertension was sent to the emergency department following an outpatient magnetic resonance cholangiopancreatography for persistent right upper quadrant discomfort. This had incidentally revealed a 6.7 cm T2-hyperintense mass with no internal enhancements within the left atrium (Figure 1A). On further questioning, the patient reported months of exertional fatigue and dyspnea, attributed to generalized deconditioning and comorbidities.
Transthoracic echocardiography showed an irregular, heterogeneous, stalked left atrial mass measuring 6.3 cm × 3.7 cm attached to the interatrial septum (Figure 1B). The mass prolapsed into the mitral orifice, resulting in dynamic obstruction and severe functional mitral stenosis (mean gradient 9 mmHg).
Left ventricular systolic function was preserved, with an ejection fraction of 56%. Imaging findings were clearly suggestive of a sizeable atrial myxoma.
Surgical excision was performed urgently, given the hemodynamic effects, and revealed a fragile, frond-like mass emanating from the left atrial septal wall. Histopathology confirmed the diagnosis of atrial myxoma (Figure 2).
Cardiac myxomas are the most common primary cardiac tumor, often originating in the left atrium. They may present with obstructive, embolic, constitutional, or nonspecific symptoms, depending on size and mobility.1–4
Although echocardiography remains the diagnostic gold standard, this case highlights the critical role of cross-sectional imaging in uncovering silent but potentially life-threatening cardiac pathology.1
This case also underlines the importance of maintaining a high index of suspicion for structural heart disease, even when presenting symptoms are nonspecific.
Although abdominal pain is not a classic symptom of myxoma, the patient’s pain improved after excision, suggesting a potential causal relationship. Possible physiologic explanations include hepatic congestion from obstructed mitral inflow or microembolic phenomena affecting the splanchnic circulation.5