Figure 1
Teaching Case
SectionCardiovascular
Case TypeClinical Cases
AuthorsLombardi M, Giusti S, Zampa V
Connected authors
18 years, female
An asymptomatic 18-year-old female patient came to our department to undergo a routine echocardiography.
Multiple mixomas.
The patient's medical history showed that three years earlier an intervention for curettage of mitral leaflets had been performed. The patient came to our department to undergo a routine
echocardiography; the results of which revealed the presence of a mass in the left ventricle.
The images show the presence, within both the right and the left ventricles, of nodular masses with a similar signal behaviour in the different sequences adopted. The inhomogeneous signal pattern
shown either before or after contrast administration is typical of cardiac mixoma. In 81% of the cases, haemorrhage, thrombosis or haemoglobin catabolites (such as haemosiderin) are found within the
mass; thus the dis-homogeneous signal. Also calcifications, which are found in 56% of cases, can induce hypointensity of the signal in GRE T2* images (1-3). In triple IR, as well as in T2 images, the
high signal intensity derives from the mixoid tissue (4). Necrotic or cystic areas show low enhancement after contrast administration (5). These neoplastic masses originate from undifferentiated
mesenchymal cells with multi-potential capability. “Sporadic” and “non-sporadic” mixomas have been described. The latter are associated with local recurrence and a distant
embolisation and can be a part of a heritable syndrome involving the skin, endocrine tumours and lentiginosis. Apparently, these kinds of mixomas can have an abnormal DNA pattern, an issue which is
still under investigation. This case has the peculiarity of the presence of multiple mixomas: the two shown in the present examination, and a previous one which was surgically removed, on the mitral
leaflet. These findings can raise the suspicion of a “non-sporadic” form of mixoma. Usually, echocardiography is a suitable technique for an accurate diagnosis. However, an MRI has the
potentiality to provide a better definition of the histological and spatial characteristics of the tumour.
References
[1] Grebenc ML, Rosado-de-Christenson ML, Green CE et al. Cardiac myxoma: imaging features in 83 patients. Radiographics. 2002 22(3):673-689. (PMID: 12006696)
[2] Burke AP, Virmani R. Cardiac myxoma: A clinicopathologic study. Am J Clin Pathol. 1993 Dec;100(6):671-80. (PMID: 8249916)
[3] Seelos KC, Caputo GR, Carrol CL, et al. Cine gradient refocused echo (GRE) imaging of intravascular masses: differentiation between tumor and nontumor thrombus. J Comput Assist Tomogr. 1992 Mar-Apr;16(2):169-75. (PMID: 1545012)
[4] Masui T, Takahashi M, Miura K, et al. Cardiac myxoma: identification of intratumoral hemorrhage and calcification on MR images. AJR Am J Roentgenol. 1995 Apr;164(4):850-2. (PMID: 7726036)
[5] Matsuoka H, Hamada M, Honda T, et al. Morphologic and histologic characterization of cardiac myxomas by magnetic resonance imaging. Angiology. 1996 Jul;47(7):693-8. (PMID: 8686964)
Case information
| URL: | https://www.eurorad.org/case/3764 |
| DOI: | 10.1594/EURORAD/CASE.3764 |
| ISSN: | 1563-4086 |
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