Multiple Intracardiac Masses: Myxoma, Thrombus or Metastasis: A Case Report

Wei-Chieh Lee; Min-Ping Huang; Morgan Fu

Disclosures

J Med Case Reports. 2015;9(179) 

In This Article

Abstract and Introduction

Abstract

Introduction: The incidence of multiple intracardiac mass is rare. The differential diagnosis of intracavitary mass lesions includes benign, malignant primary, secondary metastatic cardiac tumors, or thrombus.

Case presentation: We report the case of a 49-year-old Asian woman, who experienced a 2-week history of progressive exertional dyspnea, orthopnea, bilateral lower limb edema and palpitations. Transthoracic echocardiography showed one fixed round hyperechoic mass with central necrosis over the left ventricular apex, one oscillating hyperechoic nodule over the anterior mitral annulus and one irregularly heterogeneous mass bulging out from the lateral wall of the right atrium. The incidence of multiple myxomas is rare. Unfortunately, high tumor marker, serum lactic dehydrogenase and serum uric acid levels were also present. We could not differentiate between diagnoses of multiple myxomas with thrombi or multiple metastatic tumors.

Conclusions: Primary intracardiac tumors are rare. Approximately 75% are benign, and approximately 50% are myxomas, which have an incidence of 0.0017% in the general population. Multiple intracardiac myxomas account for less than 5% of all cases of myxoma. Our case was an atypical picture of right atrial (RA) myxoma, as it was located in the RA lateral wall and extended to the RA auricle at the junction among the superior and inferior vena cava. Two masses in the left ventricle (LV) were thrombi and resolved after heparinization. Initially, elevated tumor markers and high serum uric acid and high serum lactic dehydrogenase levels were related to necrotic tumor-derived tissue, decompensated heart failure with pleural effusion and renal insufficiency. We share our experience of multiple intracardiac masses. Whether the intracardiac mass is benign or malignant, we recommend surgery due to the possibilities of systemic or pulmonary massive embolism, infection, arrhythmia and sudden death if the thrombus ruptures or the mass dislodges.

Introduction

The incidence of multiple intracavitary masses is rare. Echocardiography is a good tool to detect intracardiac masses, and the differential diagnosis must include thrombus, vegetation and a foreign body. Multiple intracardiac myxomas account for less than 5% of all cases of multiple intracardiac masses.[1] Secondary or metastatic tumors are 20–40 times more frequent than primary tumors. We share our experience about the approach to multiple intracardiac masses and show evidence of intracardiac thrombus resolution after treatment.

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