Cardiac myxoma

Most common benign tumor
25% of primary cardiac neoplasms
Common in women
Asymptomatic in some
Triad of findings
- Peripheral embolic phenomena
- Symptoms and signs of mitral valve obstruction
- Fever, anemia, raised ESR, clubbing
Familial myxomas
- <10% of all myxomas
- Median age 20 years
- Multiple myxomas at atypical locations
- Spotty skin pigmentation and endocrine abnormalities in Carney complex

90% solitary
Size from 1 to 15 cm
Arise in left atrium (75%), right atrium (20%)
Attached to interatrial septum near fossa ovalis
It can grow through fossa ovalis into both atria
Pedunculate or polypoid with lobulated surface
If pedunculated, lesion is mobile
Chest Xray
- Heart enlarged
- Left atrial enlargement
- When calcified (rarely) appears on Xray
- Signs of pulmonary venous hypertension, pulmonary edema and rarely pulmonary arterial hypertension may be seen
ECHO
- First-line investigation
- Sufficient usually
- Hyper echoic mass attached to interatrial septum
- Heterogeneous texture in large lesions
- Pedicle easily seen
ECG-gated CT
- Intracavitary mass with well defined margins and lobulated surface
- Heterogeneously hypodense
- Foci of calcification seen in 14% cases, mainly in right sided lesions
- No arterial enhancement
- Heterogeneous enhancement seen in delayed phase
- Intracavitary thrombi is the differential which does not enhance and has no pedicle. Prolapse through the mitral orifice favors myxoma
MRI
- Hypo on T1, hyper on T2
- Mixed signal on T2* based on blood products and calcium
- SSFP: hypointense to blood pool and hyper intense to myocardium
- Moderate enhancement with gadolinium seen in delayed phases and not in first pass
- cine-MRI demonstrates mobility of lesion and prolapse through the AV valves in diastole
- Thrombus: appears usually in an enlarged atria, often arises from appendage, atrial fibrillation often present and they do not enhance