Large Left Atrial Mass Research Articles

Left Atrial Mass: Thrombus Mimicking Myxoma

A 31-year-old woman underwent elective transthoracic echocardiography for paroxysmal atrial fibrillation, which showed a large left atrial mass. A two-dimensional echocardiogram showed a large left atrium mass. Subsequent transesophageal echocardiography showed a 3 cm x 3 cm circular mass with smooth contours. The differential diagnosis included myxoma versus thrombus, but because of morphology and mobility of the mass, it was difficult to differentiate one from the other. The patient had been on chronic coumadin therapy for paroxysmal atrial fibrillation. An operation was performed and the intracardiac mass resected. On pathologic examination the mass was diagnosed as an organized thrombus. A brief review of the literature has been presented to discuss the differential diagnosis of the mass in the left atrium.

Transesophageal echocardiography in the evaluation of cardiac myxoma: A case of familial myxoma

The vast majority of atrial myxomas are readily apparent on standard transthoracic echocardiography. We present the case of a young woman with known history of familial myxoma, in whom a large left atrial mass was identified on transthoracic echocardiography. Transesophageal study more clearly delineated the extent and origin of the tumor. In addition, an unsuspected tumor in the right ventricle was also identified. These findings were confirmed at surgery, and both masses were excised. The advantages of transesophageal echocardiography in evaluation and management of this unusual subset of patients with cardiac tumor are discussed.

Transesophageal Echocardiographic Diagnosis of Intussusception of the Left Atrial Appendage

Intraoperative postbypass transesophageal echocardiography demonstrated a large pedunculated left atrial mass secondary to invagination of the left atrial appendage into the left atrial cavity. The base of the mass was between the entrance of the left upper pulmonary vein and the posterior attachment of the mitral valve at the atrioventricular groove, and the body of it protruded into the left atrium and mitral funnel. Retraction of the appendage to its normal position resulted in disappearance of the mass. This diagnosis should be considered when a pedunculated mass with these morphological features is encountered in this setting. (ECHOCARDIOGRAPHY, Volume 10, November 1993)

Diagnosis of left atrial myxoma at routine coronary angiography in an asymptomatic patient

Asymptomatic atrial myxomas are very rare and are usually diagnosed at echocardiography. Abnormal left atrial vascularity was seen as an incidental finding in an asymptomatic patient at coronary angiography. Transesophageal echocardiography revealed a large left atrial mass and a left atrial myxoma was removed at surgery. The patient remains well.

Large Left Atrial Thrombus

Figure 1. Large Left Atrial Thrombus. This four-chamber view of the heart (Panel A) was obtained by transesophageal echocardiography in a 75-year-old man with longstanding nonvalvular atrial fibrillation who had recently had a transient ischemic attack. A large, immobile thrombus (T in the schematic drawing in Panel B) is attached to the posterior wall of the left atrium (LA). A smaller thrombus (T) is attached to the lateral wall of the right atrium (RA). A third thrombus was present in the left atrial appendage (not shown). The large left atrial mass is unlikely to be a myxoma because of the . . .

Cardiopulmonary Metastatic Lesions of Osteosarcoma and Associated Cerebral Infarction

Osteogenic sarcoma frequently disseminates by hematogenous routes. A 32-year-old patient underwent evaluation for an acute cerebral infarction. Cardiac auscultation disclosed an abnormal diastolic sound. Echocardiographic examination revealed a large left atrial mass, which was found at thoracotomy to be metastatic osteogenic sarcoma. Cerebral computed tomographic scans at the time of initial examination and 3 months later demonstrated new cerebral lesions consistent with metastatic growths. The abrupt cerebral infarction, other clinical findings, and results of diagnostic studies strongly suggested that the acute cerebrovascular event was the result of metastatic cerebral embolization from the tumor material found in the thorax. Cerebral infarction is an unusual and catastrophic complication of thoracic metastatic lesions of osteogenic sarcoma.

Malignant Fibrous Histiocytoma of the Heart Presenting as Hemoptysis: Association with Pseudothrombocytopenia

A 24-year-old patient presented with hemoptysis. Pulmonary evaluation was unrevealing. After being lost to follow-up, he again presented with worsening symptoms and physical findings of severe pulmonary hypertension. A large left atrial mass was found on echocardiogram. This was subsequently found to be a malignant fibrous histiocytoma. He also had pseudothrombocytopenia due to platelet cold agglutinins. Left atrial masses must be considered in unexplained hemoptysis.

Computerized tomography in intracardiac tumors

Two cases of cardiac tumors were studied by computerized tomography. The first patient presented with cerebral embolization from left atrial tumor. Chest X-ray showed calcification in the region of the atria. A 2-“D” echo showed tumors of the right and left atrium. CT studies with contrast confirmed tumors of right and left atria its relationship with atrial septum and calcification. This is the first case report in the literature of multicentric biatrial tumors thought to be myxomas shown by computerized tomography. The second patient presented with weight loss, progressive weakness, shortness of breath and palpitations. A 2-“D” echo showed a large pedunculated left atrial mass prolapsing across the mitral valve into the left ventricle. CT with contrast showed large mass 3.5 × 4.5 cm in the left atrium. At surgery, this was proved to be a left atrial myxoma.

Real Time Two-Dimensional Echocardiography in the Diagnosis of Left Atrial Myxoma

A patient with a left atrial myxoma is reported in whom M-mode echocardiography was atypical and misleading since in most transducer positions, no tumor echoes were found in the left atrium. Real time two-dimensional echocardiography provided a definitive diagnosis, demonstrating a large left atrial mass with multiple areas of calcification. One such calcified area was located adjacent to the posterior aortic wall, and the tumor echoes were sparsely imaged directly behind it due to incomplete penetration of the ultrasound beam through dense calcification (acoustic shadowing). Difficulty in M-mode diagnosis appeared to result from this acoustic shadowing effect. In our patient, two-dimensional echocardiography was superior to the M-mode in making a definitive diagnosis of left atrial tumor because of the difficulty visualizing tumor echoes in the left atrium.