Cardiac magnetic resonance imaging and a rare case of an atrial myxoma causing an atrial septal defect

Figures

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  Fig. 1. Transthoracic echocardiogram. (A) Gray-scale ultrasound image showing the left atrial mass with its distal tip (arrow) descending into the left ventricle during ventricular diastole. (B) Color Doppler image showing directional flow toward the ultrasound transducer and into the right atrium, signifying an atrial septal defect with left-to-right blood flow.

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  Fig. 2. Transesophageal echocardiogram. (A) Gray-scale ultrasound image showing the heterogeneous left atrial mass as it extends across the mitral valve (arrow). (B) Color Doppler image again showing the atrial septal defect with left-to-right blood flow through the patent foramen ovale. LA, left atrium; LV, left ventricle; RA, right atrium.

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  Fig. 3. Cardiac magnetic resonance (CMR) imaging. (A) T1-weighted horizontal 4-chamber view showing predominantly isointense signal throughout the mass (arrow). (B) T2-weighted horizontal 4-chamber view showing that the mass is well-circumscribed, respecting tissue planes, and with high-intensity signal throughout (arrow). (C) Vertical long-axis late gadolinium-enhanced (LGE) view showing moderate heterogenous enhancement throughout the mass (arrow). (D) Oblique gradient echo (GRE) view showing the mass (thick arrow) and relation to the patent foramen ovale (thin arrow).

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  Fig. 4. Mass histology. (A) Low power micrograph shows interface of the tumor with normal myocardium. (B) High-power micrograph shows bland spindled cells with eosinophilic cytoplasm and abundant myxoid background.