Biatrial thrombi resembling myxoma regressed after prolonged anticoagulation in a patient with mitral stenosis: a case report

Case report: A rare case of recurrent right atrial mass dramatically disappeared after anticoagulation

A young man repeatedly found a right atrial mass with severe wheezing and extreme dyspnea. His condition was critical and complicated. The process of correct diagnosis was full of twists and turns. Finally, he got better and was discharged from the hospital after anticoagulation therapy, which suggested that correct clinical thinking and decision are particularly important in the process of diagnosis and treatment.

Massive Mural Thrombus Masquerading as Myxoma

A 75-year-old Caucasian female with a past medical history including insulin-dependent diabetes mellitus, hypertension, and dyslipidemia, presented to the emergency room for having palpitations for three weeks. Echocardiography revealed a very large left atrial mass mimicking myxoma. Mass was excised and examined by pathology, revealing a mural thrombus. A mural thrombus is not an uncommon mass found in the left atrium. However, it does not often present symptomatically, strongly mimics an atrial myxoma on cardiac imaging, and has rarely ever been reported to be greater than seven centimeters in any dimension. We present a case of a 75-year-old Caucasian woman with a massive, symptomatic cardiac thrombus masquerading as a myxoma on imaging.

Disappearing "Myxoma": Left Atrial Thrombus Masquerading as a Myxoma

Intracardiac masses can be challenging to differentiate by echocardiography. We present a case of several intracardiac masses with echocardiographic features of both thrombi and myxoma in a patient with heart failure symptoms. The masses were confirmed to be thrombi after complete resolution on repeat echocardiography following anticoagulation. Echocardiography complements the history and physical exams in diagnosing intracardiac masses but may present a diagnostic challenge when features are not pathognomonic. Follow up imaging after anticoagulation should be standard of care to avoid unnecessary surgeries when the diagnosis of a cardiac mass is uncertain.

A Biatrial Myxoma with Triple Ripples

Cardiac myxoma is a benign tumor, but it is known for its space-occupying effect at the site of origin and frequent systemic embolization. This case report highlights a biatrial myxoma of interatrial septum who presented with significant tricuspid valve regurgitation, atrial fibrillation, and cardioembolic stroke of the left parietal lobe, i.e., a biatrial myxoma with triple ripples.