Differentiating diagnosis of atypical cardiac myxoma and thrombus by coronary computed tomography angiography imaging

Cardiac atypical myxoma usually presents as an isolated mass attached to the atrial septum on imaging, with no movement and a wider attachment base. It is difficult to distinguish it from cardiac thrombus through conventional echocardiography or computed tomography. The purpose of this study is to evaluate the value of coronary computed tomography angiography (CCTA) imaging features in distinguishing cardiac atypical myxoma from cardiac thrombus. This retrospective study included patients with atypical myxoma of the heart confirmed by histopathology (n = 18) and with thrombus disappearance after anticoagulation treatment (n = 23). All patients underwent CCTA examination. There are significant differences in the origin, surface, and enhancement patterns between cardiac myxoma and thrombus groups (p < 0.05, respectively). Specifically, supplied vessels were observed in the cardiac atypical myxoma group, while no neovascularization was detected in the thrombus group (83.33% vs. 0%, p < 0.001). Non-invasive CCTA can distinguish atypical cardiac myxoma and cardiac thrombus through image features, and will play an important role in the diagnosis and follow-up of future cardiac lesions.