Cardiac Myxoma With Gamna-Gandy Bodies in a Nicaraguan Patient: Leveraging Advanced Imaging to Reduce Mortality Risk

Figures

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  Figure 1. Anteroposterior Chest Radiograph The image reveals a pattern of bilateral alveolar infiltrates, most prominent in the perihilar regions, suggestive of a "butterfly wing" distribution. Linear opacities, identified as Kerley B lines (marked with red arrows), are observed in the lower lung fields, consistent with interlobular septal thickening. The cardiothoracic ratio was assessed using heart and chest widths, as indicated by blue lines: heart width, 17.89 cm; chest width, 29.73 cm. The calculated cardiothoracic ratio (CTR) is approximately 0.60 (17.89 cm / 29.73 cm), exceeding the threshold of 0.50, indicative of cardiomegaly.

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  Figure 2. Echocardiographic Findings of an Intra-Atrial Mass A. Transesophageal echocardiogram, a parasternal long-axis view at 140 degrees, demonstrates an echogenic mass occupying the left atrium, with its outline highlighted by red arrows. B. Transesophageal echocardiogram, a parasternal long-axis view at 130 degrees, reveals an echogenic mass prolapsing through the mitral valve into the left ventricle, with its silhouette delineated by light blue arrows. C. Transthoracic echocardiogram, apical four-chamber view at the mitral valve level, shows an echogenic mass measuring 52.3 mm x 41.8 mm. D. Transthoracic echocardiogram, apical four-chamber view, depicts an echogenic mass prolapsing through the mitral valve into the left ventricle, with its outline marked by light blue arrows.

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  Figure 3. Cardiac Magnetic Resonance Imaging A mobile, oval-shaped mass measuring 55 x 39 mm, adherent to the interatrial septum, is identified. A. SSFP sequence, four-chamber view during diastole, demonstrates a left intra-atrial space-occupying lesion with apical displacement toward the left ventricular inflow tract, resulting in partial obstruction. B. SSFP sequence, two-chamber view during diastole, reveals a left intra-atrial space-occupying lesion. SSFP, steady-state free precession.

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  Figure 4. Histopathological Findings of a Cardiac Myxoma Specimen (H&E Staining) A. At 4× magnification, a stellate cell (indicated by a dotted red arrow) is observed within a myxoid matrix. Spindle-shaped nuclei with abundant eosinophilic cytoplasm and hemosiderin deposits (marked by black arrows) are prominent. B. At 20× magnification, the myxoid matrix contains notable stellate cells (outlined in red in the lower right corner) alongside areas of recent hemorrhage. C. At 20× magnification, myxoma cells are arranged in nests and cords within a fibromyxoid matrix. D. At 40× magnification, Gamna-Gandy bodies (outlined in red in the lower right corner) are identified within the cardiac myxoma, representing sclerosiderotic lesions composed of collagen fibers impregnated with calcium and iron deposits. H&E, hematoxylin and eosin