Left atrial myxoma – echocardiogram in parasternal long axis view

Left atrial myxoma – echocardiogram in parasternal long axis view

Brief Review with Echocardiogram video

Left atrial myxoma in parasternal long axis viewMyxoma is a primary cardiac tumour, which is much less common than the secondary cardiac tumours. Echocardiogram demonstrates left atrial myxoma very well.

Left atrial myxoma in parasternal long axis view - annotated
Left atrial myxoma in parasternal long axis view

 

Left atrial myxoma prolapsing into LV in diastole
Left atrial myxoma prolapsing into LV in diastole

Myxoma is seen on echocardiogram in parasternal long axis view as a mass prolapsing into the left ventricle in diastole. The site of attachment of the myxoma is not evident in this view. A four chamber view had shown that it is actually attached to the interatrial septum. Myxoma is the commonest primary cardiac tumour in the adult, and it is usually seen in the left atrium. Right atrial myxomas are rare. Percutaneous ablation and retrieval of a right atrial myxoma has been reported, though usual approach for removal of myxomas is open surgery [1]. Rarely myxomas can occur in the right ventricle [2] and the left ventricle [3]. Sometimes myxomas can be familial. Familial myxomas can occur as part of Carney’s complex, with associated skin pigmentation abnormalities (lentigines), endocrine tumours and schwannomas [4]. Two thirds of the myxomas associated with Carney’s complex have been shown to have PRKAR1A mutations [5].

Left atrial myxoma with mitral regurgitation jet
Left atrial myxoma with mitral regurgitation jet

Mosaic mitral regurgitation jet is seen in the left atrium skirting the myxoma anteriorly and left atrial wall posteriorly.

Reference

  1. Konecny T, Reeder G, Noseworthy PA, Konecny D, Carney JA, Asirvatham SJ. Percutaneous ablation and retrieval of a right atrial myxoma. Heart Lung Circ. 2014 Nov;23(11):e244-7.
  2. Mitropoulos F, Giannakoulas G, Kallifatidis A, Kanakis M, Kiaffas M, Chatzis AC. Right ventricular myxoma in a patient with tetralogy of Fallot. Int J Surg Case Rep. 2014;5(12):1058-60.
  3. Song X, Tang L, Yang J, Li N. Recurrence of nonfamilial cardiac myxoma in the left ventricle: a case report. J Clin Ultrasound. 2014 Nov-Dec;42(9):576-7.
  4. Zhang YL, Wang XC, Yu W, Pei LP, Ma Y, Jiang S, Sun YP. A case of familial Carney complex. Arch Iran Med. 2015 May;18(5):324-8.
  5. Maleszewski JJ, Larsen BT, Kip NS, Castonguay MC, Edwards WD, Carney JA, Kipp BR. PRKAR1A in the development of cardiac myxoma: a study of 110 cases including isolated and syndromic tumors. Am J Surg Pathol. 2014 Aug;38(8):1079-87.

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