Novel contrast echocardiographic features of cardiac myxoma with cystic degeneration: a case report

• Published in: Hong Kong medical journal = Xianggang yi xue za zhi 2023-12, Vol.29 (6), p.545
• Main Authors: Lee, D P H, Ho, T W, Wong, I M H, Wong, E C Y, Lee, M K Y
• Format: Article
• Language: English
• Subjects: Angiogenesis; Ankle; Blood vessels; Case reports; Echocardiography; Emergency medical care; Heart; Heart Neoplasms - diagnostic imaging; Humans; Myxoma - diagnostic imaging; Pulmonary hypertension; Tumors; Vascular endothelial growth factor
• ISSN: 1024-2708; 2226-8707
• DOI: 10.12809/hkmj2210246

CC BY-NC-ND 4.0 CASE REPORT Novel contrast echocardiographic features of cardiac myxoma with cystic degeneration: a case report Derek PH Lee, MB, ChB, FHKCP1; TW Ho, MB, BS2; Ivan MH Wong, MB, BS, FHKCP1; Eric CY Wong, MB, BS, FRCP1; Michael KY Lee, MB, BS, FRCP1 1 Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China 2 Department of Pathology, Queen Elizabeth Hospital, Hong Kong SAR, China Corresponding author: Two-dimensional transthoracic echocardiographic examination of the cardiac mass of the patient. (a) Double-barrel[-]shaped left atrial myxoma with central echolucent space (arrow). (b) Doppler mitral inflow showing significant gradient acrossmitral valve. (c) Early contrast phase showing enhancement of the stalk of cardiac myxoma. (d) Delayed contrast enhancementof echolucent space. (e) Homogeneous opacification of previous echolucent space of the cardiac myxoma (arrow). (f) Earlycontrast washout prior to the cardiac chambers Urgent in-house cardiothoracic surgical consultation was obtained and immediate open-heart excision of the cardiac tumour was performed. No significant mitral regurgitation was detected with saline testing and there was no interatrial flow detected on intraoperative transoesophageal echocardiography following resection. Gross (a and b) and microscopic (c to e) examination of excised cardiac mass of the patient. (a) Gross examination of intact specimen with cauterised base (arrow). (b) Serially sectioned specimen showing prominent cystic change with solidmyxoid areas near the base. (c) Thick-walled blood vessels (arrow) at the base/stalk of the lesion (haematoxylin and eosinstaining, [x]4). (d) Tumour cells showing classic concentric arrangement around capillary (arrow) and classic ‘halo of matrix'around cellular clusters (haematoxylin and eosin staining, [x]20). (e) Immunostaining for calretinin showing positive nuclearstaining in tumour cells (immunohistochemical stain with calretinin, [x]4) Management The patient made an uneventful postoperative recovery and pre-discharge echocardiogram showed no residual mass, significant mitral regurgitation or pericardial effusion.