Ultrasound Case 080

Presentation

A previously well 56 year old presents after a flight. She has had some fleeting chest discomfort and some mild shortness of breath.

Image 2: Parasternal long axis.
Image 3: Apical 5 chamber view 

Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Subcostal view.

There is a whopping great big mass sitting in the left atrium. With each atrial contraction it moves forward and obstructs forward flow. This is causing pulmonary oedema – see the B-lines around the heart? She also had small pleural effusions.

Oh yes, and the other basic echo questions we should always ask – the RV looks OK, the LV if anything looks underfilled. Funny that. And there is no significant pericardial effusion.

She was admitted by cardiothoracics and taken to theatre.

Typically, myxoma manifest as a solitary, pedunculated, mobile mass in the left atrium (LA) with a stalk that is attached to the inter-atrial septum. Alternate diagnostic possibilities for left atrial masses include thrombus, lipoma, sarcoma and metastasis.

Image 2: Parasternal long axis.

Image 3: Apical 5 chamber view


CLINICAL CORRELATION

Left atrial tumour – atrial myxoma

Popping the probe on to every patient you see with shortness of breath or chest pain sometimes reveals unanticipated findings.



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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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