case_images: PMC6188732_01
case_images: (a) Transthoracic echocardiogram with right ventricular myxoma (arrow). (b) Transthoracic echocardiogram with agitated saline revealing a right ventricular myxoma measuring 2.78 cm x 1.8 cm.
case_images: CRIC2018-9231256.001.jpg
case_images: PMC6188732_01_CRIC2018-9231256.001.jpg
case_images: fig1
case_images: Subsequently, a transthoracic echocardiogram was performed and revealed a mass in the right ventricle attached to the posterior wall and prolapsing into the right ventricular outflow tract (RVOT) in systole (Figure 1).
case_images: (a) RV myxoma on TEE (arrow). (b) Color flow around RV myoxoma on TEE.
case_images: CRIC2018-9231256.002.jpg
case_images: PMC6188732_01_CRIC2018-9231256.002.jpg
case_images: fig2
case_images: Next, a transesophageal echocardiogram was performed to better characterize the mass, which measured 2.6 cm x 4.1 cm and was mobile and prolapsed into the RVOT during systole resulting in a mild dynamic obstruction (Figure 2(a)). Color Doppler revealed turbulent flow in the RVOT and pressure gradient measurements revealed a gradient of 26 mmHg across the RVOT while the patient was heavily sedated and in a supine position (Figure 2(b)).
case_images: RV mass appreciated on cardiac catheterization.
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case_images: PMC6188732_01_CRIC2018-9231256.003.jpg
case_images: fig3
case_images: The patient was referred to cardiothoracic surgery for further evaluation and underwent a cardiac catheterization prior to thoracotomy which also showed evidence of a RV mass (Figure 3).
case_images: RV myxoma excised.
case_images: CRIC2018-9231256.004.jpg
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case_images: fig4
case_images: A thoracotomy with excision of the mass was performed (Figure 4), and pathological examination revealed the mass as a myxoma (Figure 5).
case_images: The tumor is comprised of spindled or stellate cells with eosinophilic cytoplasm and uniform, round nuclei with inconspicuous nucleoli in a background of myxoid stroma. Chronic inflammatory cells including hemosiderin-laden macrophages are also present. The cellularity is variable; however, no foci of increased cellularity marked nuclear pleomorphism or increased mitotic activity seen.
case_images: CRIC2018-9231256.005.jpg
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case_images: fig5
case_images: A thoracotomy with excision of the mass was performed (Figure 4), and pathological examination revealed the mass as a myxoma (Figure 5).
case_images: (a) Subcostal view on transthoracic echocardiogram two years postprocedure without evidence of recurrence of RV myxoma. (b) Apical view from the same study (arrow: right ventricle).
case_images: CRIC2018-9231256.006.jpg
case_images: PMC6188732_01_CRIC2018-9231256.006.jpg
case_images: fig6
case_images: Repeat echocardiogram two years postresection did not reveal any evidence of recurrence of the myxoma (Figures 6(a) and 6(b)).