Key result
Left atrial myxoma excision leads to complete resolution of an apparent IVC pseudo-thrombus.
Why the study?
IVC hyperechoic structures detected by echocardiography are uncommon and usually associated with thrombosis or cancer, but their etiology can sometimes be unclear despite multimodality imaging.
Case Report (n=1)
No
This case highlights the importance of integrating multimodality imaging to differentiate true IVC thrombus from pseudo-thrombus (such as artifacts or spontaneous echo contrast) in patients with cardiac myxoma.
Multimodality imaging may avert misdiagnosing IVC pseudo-thrombus in myxoma; leaves open prevalence and generalizability.
Background IVC hyperechoic structure detected by echocardiography is relatively uncommon and is usually associated with deep vein thrombosis and cancers. In most cases, the etiology can be clarified using computed tomography (CT) and magnetic resonance imaging (MRI). However, we encountered an IVC hyperechoic structure that was not confirmed by multimodality imaging in a patient with cardiac myxoma. Case presentation A 62-year-old woman presented with sudden-onset left hemiplegia and right homonymous hemianopsia. On arrival, her left arm was cold to the touch. Contrast-enhanced CT demonstrated a left atrial mass, left subclavian artery occlusion, and splenic infarction. Brain MRI revealed an acute infarction in the right occipital lobe. Transthoracic echocardiography (TTE) showed a mobile mass in the left atrium and a 33 mm immobile linear hyperechoic structure with surrounding blood flow in the suprarenal IVC, suggestive of organized thrombus. However, laboratory tests showed no elevation of D-dimer, and cardiac MRI did not confirm any IVC lesion. During surgical planning, there was concern that IVC cannulation via the right atrium for CPB might dislodge a potential thrombus and cause pulmonary embolism. Preoperative transesophageal echocardiography under general anesthesia demonstrated no IVC hyperechoic structure. An IVC cannula was inserted via the right femoral vein under fluoroscopic guidance. Following cardiac arrest and right atriotomy, direct inspection revealed no thrombus or other abnormal structure within the suprarenal IVC. The left atrial tumor was excised via left atriotomy. Histopathological examination confirmed cardiac myxoma. Postoperative TTE showed complete disappearance of the IVC hyperechoic structure. Conclusions We report a rare case of IVC hyperechoic structure mimicking a true thrombus in a patient with cardiac myxoma. This phenomenon may be related with spontaneous echo contrast and echocardiographic artifacts. Our case highlights an important diagnostic pitfall in echocardiographic assessment of the IVC and emphasizes the importance of integrating findings from multiple imaging modalities.
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Yasumura et al. (2026) conducted a case report in Cardiac myxoma (n=1). Surgical excision of cardiac myxoma was evaluated on Disappearance of IVC hyperechoic structure. Surgical excision of a left atrial cardiac myxoma resulted in the complete disappearance of a preoperatively observed IVC hyperechoic structure, suggesting it was a pseudo-thrombus.
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