3 | DISCUSSION
Cardiac myxoma is common primary
benign cardiac tumor in the middle-aged female.
Three-quarters of cardiac myxomas were located in the left atrium
[1]. Most of the rest occurred in
the right atrium. RV myxomas were reported in
just 3–4% of cardiac myxoma cases
. But in our case, it was a RV myxomas occurred in a young man. Cardiac
myxoma is often
attached to heart chamber wall with a narrow pedicle, and its surface is
smooth or
papillary, or villous. In our report, it has a wide base pedicle, and
the surface was papillary.
There has study reported that the morphology of cardiac myxoma,
especially for villous or
papillary myxomas, is important predictor of pulmonary embolism (PE)
event. All the TTE imaging
indicated the myxoma is fatal, particularly maybe PE occur.
PE caused by myxoma
has an extremely low incidence . There has almost no reports about it
during TTE till now. In our report, the patient suddenly felt
chest pain and difficult
respiratory during TTE, it was suggested PE maybe occur. We contacted
the department of radiology immediately. Emergency lung
Contrast-enhanced CT and CTPA was performed for the patient, and the
results showed PE occurred, surgery was operated subsequently. Of
course, contrast-enhanced ultrasound (CEUS) can identify the nature of
cardiac mass [5], but considering the potential danger of PE, CEUS
was no further performed. At last, the young man was pulled back from
the dangerous situation. It was attributed to prompt management of
heart-team members.
All in all, early diagnosis and surgical resection are most important
for life-threatening PE of myxoma. Due to the interval from resection to
recurrence ranging from a few months to 8 years, with recurrence rate of
myxomas approximately 1% to 4% [6], so long-term follow-up
echocardiography is recommended particularly in adolescents.