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(Circulation. 2004;109:e165-e166.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Prolapsing Atrial Myxoma

Dynamic Visualization With Multislice Computed Tomography

Gudrun Feuchtner, MD; Silvana Mueller, MD; Johannes Bonatti, MD; Guy Friedrich, MD; Dieter zur Nedden, MD; Alexander Smekal, MD

From the Department of Radiology II (G.F., D.z.N., A.S.), Department of Cardiology (S.M., G.F.), and Department of Cardiothoracic Surgery (J.B.), University Hospital of Innsbruck, Austria.

Correspondence to Gudrun Feuchtner, MD, Department of Radiology II, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria. E-mail Gudrun.Feuchtner{at}uibk.ac.at

An 80-year-old woman had a history of increasing dyspnea with a sensation of thoracic pressure. Transthoracic echocardiography demonstrated a mobile hyperechoic mass located in the left atrium (Figure 1A) and prolapsing into the left ventricle (Figure 2A). A moderate obstruction of the mitral valve was observed. The mass was suspicious for a cardiac tumor, although an additional thrombus formation could not be excluded. Accordingly, a contrast-enhanced, ECG-gated, 16-row helical CT scan (Sensation 16, Siemens) demonstrated a hypodense mass based on the atrial septum (Figure 1B). Homogenous contrast enhancement suggested a cardiac tumor. Dynamic visualization of the cardiac motion showed the mass based on the atrial septum, prolapsing during diastole into the left ventricle (Figure 2B and Data Supplement Movies). Three-dimensional image reconstruction dependent on heart phase (end diastole and end systole) with ECG gating and high temporal resolution (250 ms) improved preoperative assessment. Surgical removal of the mass proved it to be a myxoma. The postoperative course was uneventful.

View larger version (66K): [in this window] [in a new window]   Figure 1. A, Two-dimensional echocardiography showing a hyperechoic left atrial (LA) mass (arrows) based on the atrial septum (4-chamber view, end systole). The leaflets and cusps of the mitral valve (MV) are not affected. LV indicates left ventricle; RV, right ventricle; RA, right atrium. B, ECG-gated multislice CT demonstrating a hypodense mass (arrows) (4-chamber view, end systole). Three-dimensional reconstruction and display as thin-slice maximum-intensity projection (MIP). Homogenous opacification of cardiac chambers was obtained with a low contrast agent flow rate (1 mL/s) and relatively long scan delay acquired in a breath-hold of 30 s.

View larger version (64K): [in this window] [in a new window]   Figure 2. A, Two-dimensional echocardiography: The hyperechoic mass is prolapsing over the anterior (mitral) cusp in the left ventricle (LV) (4-chamber view, end diastole). The mass is located upside the anterior leaflet but not adjacent to it. Abbreviations as in Figure 1. B, ECG-gated multislice CT demonstrating a hypodense mass (arrows) prolapsing into left ventricle during end diastole. The mass can be differentiated from the mitral cusp. The posterior cusp is not involved.

Footnotes

Movies I and II are available in the online-only Data Supplement at http://www.circulationaha.org.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Feuchtner, G. Articles by Smekal, A. Search for Related Content PubMed PubMed Citation Articles by Feuchtner, G. Articles by Smekal, A. Related Collections Echocardiography Computerized tomography and Magnetic Resonance Imaging