case_images: PMC6501262_01
case_images: Computed tomography pulmonary angiogram revealed bilateral pulmonary emboli (green arrows).
case_images: CRIC2019-5873606.001.jpg
case_images: PMC6501262_01_CRIC2019-5873606.001.jpg
case_images: fig1
case_images: In the work-up process, he was found to have no deep venous thrombosis (DVT), but computed tomography pulmonary angiogram (CTPA) showed large pulmonary embolism more on the left side (Figures 1 and 2).
case_images: Computed tomography pulmonary angiogram revealed a broad-based filling defect in the right ventricle (green arrow), with incidental finding of preoperative raised right hemidiaphragm.
case_images: CRIC2019-5873606.002.jpg
case_images: PMC6501262_01_CRIC2019-5873606.002.jpg
case_images: fig2
case_images: In the work-up process, he was found to have no deep venous thrombosis (DVT), but computed tomography pulmonary angiogram (CTPA) showed large pulmonary embolism more on the left side (Figures 1 and 2). Transthoracic and transesophageal echo confirmed right ventricular filling defect (Figure 2), which initially was thought to be a right ventricular thrombus and was placed on intravenous heparin therapy.
case_images: Coronary angiogram revealed no evidence of coronary artery disease, right coronary artery fistula, or tumour blush demonstrating blood supply to the base of tumour in the ventricular septum.
case_images: CRIC2019-5873606.003.jpg
case_images: PMC6501262_01_CRIC2019-5873606.003.jpg
case_images: fig3
case_images: An angiogram revealed incidental distal right coronary artery fistula (Figure 3), without haemodynamic compromise, likely also represents "tumour blush." During surgery on cardiopulmonary bypass (CPB), a myxoma arising from the right ventricular septum beneath the septal leaflet of the tricuspid valve, approximately 5 cm x 4 cm in size was identified (Figure 4) and removed without spilling and further fragmentation (Figure 5).
case_images: Intraoperative photograph of histologically proven large 5 cm x 4 cm right ventricular myxoma beneath the septal leaflet of the tricuspid valve. Area where part of myxoma have fragmented and embolized (arrowhead).
case_images: CRIC2019-5873606.004.jpg
case_images: PMC6501262_01_CRIC2019-5873606.004.jpg
case_images: fig4
case_images: An angiogram revealed incidental distal right coronary artery fistula (Figure 3), without haemodynamic compromise, likely also represents "tumour blush." During surgery on cardiopulmonary bypass (CPB), a myxoma arising from the right ventricular septum beneath the septal leaflet of the tricuspid valve, approximately 5 cm x 4 cm in size was identified (Figure 4) and removed without spilling and further fragmentation (Figure 5).
case_images: Pathology specimen of large 55 mm x 30 mm x 30 mm smooth right ventricular myxoma with attachment site to ventricular septum (star), part of myxoma that fragmented and embolized (asterisk), blood clot removed (arrowhead), and myxoma accessories (arrow).
case_images: CRIC2019-5873606.005.jpg
case_images: PMC6501262_01_CRIC2019-5873606.005.jpg
case_images: fig5
case_images: An angiogram revealed incidental distal right coronary artery fistula (Figure 3), without haemodynamic compromise, likely also represents "tumour blush." During surgery on cardiopulmonary bypass (CPB), a myxoma arising from the right ventricular septum beneath the septal leaflet of the tricuspid valve, approximately 5 cm x 4 cm in size was identified (Figure 4) and removed without spilling and further fragmentation (Figure 5).
case_images: Right ventricular myxoma being excised and shaved off from ventricular septum. Note the origin of tumour beneath the septal and anterior leaflets of the tricuspid valve.
case_images: CRIC2019-5873606.006.jpg
case_images: PMC6501262_01_CRIC2019-5873606.006.jpg
case_images: fig6
case_images: The tumour was shaved from the septum without creating any ventricular septal defect (VSD) and protecting the tricuspid valve leaflets (Figure 6).
case_images: Histology of ventricular myxoma.
case_images: CRIC2019-5873606.007.jpg
case_images: PMC6501262_01_CRIC2019-5873606.007.jpg
case_images: fig7
case_images: Histology of tumour and emboli both confirmed to be myxomatous in origin (Figure 7).