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- 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
Imaging
- 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