CONGRESS ABSTRACT

Cardiac myxomas (CM) are the most common primary cardiac tumors in adults, predominantly located in the left atrium. Biatrial involvement is rare. Although benign, CM can lead to significant complications, often requiring surgical removal. Echocardiography is the primary diagnostic tool, though variable morphology can make diagnosis challenging. A 53-year-old male with hypertension, smoking and obesity, was referred to the Emergency Department of Parma after an incidental finding of a suspected thrombus straddling the foramen ovale during a routine assessment for hypertension. The patient was asymptomatic. Clinical examination was unremarkable. Laboratory results showed normal inflammatory indices; high sensitivity troponin and D-dimer levels were negative. Transthoracic echocardiography (TTE) showed a mass with homogeneous echogenicity near the fossa ovalis, in the left atrium. A CT scan was negative for pulmonary embolism, but confirmed an elongated mass in the left atrium near the fossa ovalis, measuring 26 x 9 mm, with irregular borders and no significant post-contrast enhancement. Mild left ventricular wall thickening was observed. To further investigate anatomical characteristics, transoesophageal echocardiography was performed. This revealed a mobile, heterogeneous mass measuring 29 x 12 mm at the interatrial septum near the fossa ovalis. The mass had a villous shape and broad base, showing no significant contrast uptake, supporting the benign diagnosis. No abnormalities were found in the right atrium. The mass was of uncertain nature, differential diagnosis included thrombus and myxoma. However, in the context of a negative D-dimer and the absence of thrombosis risk factors, the likelihood of a villous myxoma was higher, which is more common in the fossa ovalis region. Atypical cardiac myxomas are difficult to diagnose due to their rarity and nonspecific presentation. Echocardiography is essential for diagnosis, distinguishing myxomas from malignancies and thrombi. Transthoracic echocardiography evaluates location and characteristics, while transesophageal echocardiography is critical for detailed preoperative assessment, surgical planning and monitoring for recurrence. Ultimately, the definitive diagnosis is made during surgical resection. Our patient underwent successful open-heart surgery to remove the myxoma, with a curative outcome. This case highlights the importance of multimodal echocardiography in diagnosing and managing cardiac myxomas.