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
Read more

Grebenc, Mary L., et al. “From the archives of the AFIP: cardiac myxoma: imaging features in 83 patients.” Radiographics 22.3 (2002): 673-689.

Tao, Ting Y., et al. “Pediatric cardiac tumors: clinical and imaging features.” Radiographics 34.4 (2014): 1031-1046.