Giant Right Ventricular Mass Protruding into the Pulmonary Artery during Systole

Huge right ventricular myxoma in a 15-year-old female patient: a case report and literature review

Background

Myxomas represent about 5–10% of primary cardiac tumors in children, and only about 2.5–4% of cardiac myxomas originate from ventricular chambers. Symptoms and signs of right ventricular tumors depend mainly on the size and the site of the tumor and its effect on the inflow and outflow of the blood.

Case presentation

A 15-year-old female patient presented with syncope on exertion and symptoms and signs of congestive heart failure. She had a history of dyspnea and palpitation on exertion for 2 years before admission. Echocardiography and cardiac magnetic resonance imaging (MRI) diagnose a huge right ventricular mobile mass (9 × 4.6 × 3.7 cm) prolapsing during systole into the main pulmonary artery and severe tricuspid regurgitation. The mass showed no contrast enhancement in early dynamic and delayed gadolinium images, suggestive of a thrombus. The mass was safely excised and tricuspid annuloplasty repair was done using right atriotomy and vertical right ventriculotomy approaches. The patient was discharged in a well condition on postoperative day 6. Pathologically, the mass was confirmed as cardiac myxoma with old extensive hemorrhage inside.

Conclusions

Early echocardiography is essential for patients complaining of unexplained cardiac symptoms for early diagnosis and management of rare cases. Multimodality imaging is needed for the diagnosis and planning of the surgical procedure of right ventricular masses. Hemorrhage inside myxoma may lead to no contrast enhancement of the tumor.

A rare form of cardiac myxoma: interatrial septum tumor

A myxoma is one of the most common tumors in cardiac surgery, with most of them originating from the left or right atrial walls and causing embolic complications. An 84-year-old woman was referred to our institution after echocardiography showed an interatrial septum tumor that was presumed to be a thrombus; however, postoperative pathological examination revealed it to be a cardiac myxoma. This atypical myxoma was covered with a solid capsule containing connective tissue and substantial calcifications, which had made it difficult to establish a diagnosis of myxoma.