Assessment of embolic cardiomyopathy from atrial myxoma on magnetic resonance imaging: A case report

Fig. 1. Initial magnetic resonance imaging of the brain: T2W, DWI, and ADC images (A–C) showing bilateral distribution of multiple small acute ischemic lesions and multilevel infarcts. The DWI images (B, D, E) showing restricted diffusion within the cerebellar hemispheres, as well as the temporal, parietal, and occipital cortex, primarily affecting the posterior circulation. The SWI images (F) reveal multiple old cerebral microbleeds, especially within the deep gray matter and posterior fossa."

Fig. 2. Transthoracic echocardiography during hospitalization showing a large, mobile, lobulated, heterogeneous echoic mass, attaching to the interatrial septal and prolapsing through the mitral valve in diastole, along with the reduction of wall motion in the apical region.

Fig. 3. Contrast-enhanced cardiac MRI showing a mass with an intermediate signal on T1-weighted sequences, hyperintense on cine SSFP compared to normal myocardium, and exhibiting late gadolinium enhancement. The central areas that demonstrate no enhancement correlate with hemorrhagic breakdown products (yellow arrow). Late CMR images showing multiple small myocardial scars as separate and randomly distributed lesions (blue arrow).

Fig. 4. Pathological results confirmed a left atrial myxoma characterized by gelatinous tissue attached to the tumor stalk. The tumor cells included stellate or globular myxoma cells, surrounded by ground substance containing chondroitin sulfate and hyaluronic acid, with numerous red blood cells owing to hemorrhage.

Fig. 5. Repeated cardiac MRI after 3 months showing multiple scars on 4-chamber views and short axis views.