Angiographic Visualisation of a Right Atrial Myxoma ^†

Case report

A 58-year-old woman presented with one year history of fatigue and gradually increasing exertional dyspnoea. During cardiac auscultation, an early diastolic sound compatible with a “tumour plop” could be heard. Transthoracic echocardiography (Figure 1, ¹) showed a 5.5 × 3.2 cm pedonculated mass attached to the right side of the interatrial septum prolapsing into the tricuspid orifice during diastole. Preoperative coronary angiogram revealed no significant coronary artery disease, but demonstrated a mobile mass vascularised by the left and right coronary arteries (Figure 2 and Figure 3) and dynamic coronary angiogram ^2,3). The patient underwent surgical resection of the mass and the postoperative course was uneventful. Pathological analysis confirmed the diagnosis of myxoma, the most common primary cardiac tumour in adults. Approximately 75% of myxomas occur in the left atrium, 15–20% in the right atrium and less often they may be found in the right or left ventricle [1]. The value of two-dimensional echocardiography in the diagnosis of atrial myxoma has been clearly established. In this case coronary angiography nicely demonstrates the movement of the tumour between the right atrium and ventricle. It also highlights that coronary angiogram may raise the suspicion of myxoma if not yet diagnosed, by showing a vascular blush in the tumour. Although common, the angiographic sign of “tumour vascularity” is not specific to myxoma. Selective coronary angiogram can be performed when appropriate to assess the risk of surgical resection.