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.