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.
Further Reading
- Park H et al. Differential Diagnosis of a Left Atrial Mass after Surgical Excision of Myxoma: a Remnant or a Thrombus? Korean Circ J. 2016 Nov;46(6):875-878
- Mankad R, Herrmann J. Cardiac tumors: echo assessment. Echo Res Pract. 2016 Dec; 3(4): R65–R77.
- Outline of the distribution of subtypes of cardiac masses by anatomic location
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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. | SonoCPD | Ultrasound library | Top 100 | @thesonocave |