Left atrial myxoma diagnosed and characterized by cardiac magnetic resonance imaging

An MRI Image Analysis of Primary Cardiac Neoplasms

Objective

This study aimed to examine the magnetic resonance imaging (MRI) characteristics of primary cardiac neoplastic lesions.

Methods

A retrospective investigation was conducted on 24 cases of primary cardiac neoplastic lesions as confirmed by surgery and pathology results. All the cases in this study received MRI multi-sequence and multi-dimension scanning, including the cardiac long-axis and short-axis cine sequences, parameter sequences of the cardiac long axis and short axis (T1WI, T2WI), first-pass perfusion sequence, and delayed enhancement sequence of the cardiac long axis and short axis. The age and gender of the patients and the location, size, signal characteristics, and relationship with the neighboring tissues of all the lesions were examined.

Results

Twenty-four cases of primary neoplastic lesions were examined in this study, the onset age was 11–72 years old, the median age was 53 years old, and the mean age was 46 years old. Among these cases, there were 8 cases including males and 16 cases including females, 19 cases were benign lesions; including 11 cases of myxoma, 4 cases of hemangioma, 1 case of paraganglioma, 1 case of PEcoma, 1 case of hamartoma, and 1 case of lipoma. The malignant lesions included 3 sarcomas and 2 lymphomas in 5 patients.

Conclusion

MRI imaging provides a great value in the preoperative classification of primary cardiac neoplastic lesions.

Anesthetic Management of a Patient With a Giant Right Atrial Myxoma

Cardiac myxomas account for 50% of all benign primary cardiac tumors. Rarely, these tumors occur in the right atrium (RA; 10% to 20%), with a stalk frequently attached to the interatrial septum. Right atrial myxomas can lead to RA enlargement, arrhythmias, functional tricuspid stenosis, right heart failure, and catastophic pulmonary embolization resulting in sudden cardiac death. Anesthetic management of patients with RA myxomas can be complicated by the mass effect of the myxoma, preload limitations, and the potential for cardiovascular collapse. Multimodal cardiac imaging inclusive of echocardiography, computed tomography, and magnetic resonance imaging helps with the diagnosis, preoperative optimization, and formulation of anesthetic and surgical plans. We present a case report highlighting the importance of multimodal imaging, adequate preoperative patient optimization, and the anesthetic considerations in the successful management of a patient with a giant 8.3 × 4.7 cm RA myxoma.