Extra cardiac tumor misdiagnosed as a left atrial myxoma

provided the original work is properly cited. CC Cardiac tumors, which are characterized by very a low prevalence of approximately 0.02% based on pooled data, can cause considerable morbidity and mortality due to cardiac conduction abnormalities, embolization of the tumor fragment or associated thrombus, or intra-cardiac obstructions [1]. Primary cardiac tumors are usually benign in adults, with only 20–25% cases being reported as malignant, and myxoma is the most common cardiac neoplasm, accounting for nearly 50% of cases of cardiac tumors. Myxomas most commonly originate in the left atrium; however, sarcomas may also present as a left atrial (LA) mass, and may be mistaken for a myxoma, preoperatively. For myxomas, surgical resection is adopted as a curative treatment, and transesophageal echocardiography (TEE) is currently the most powerful cardiovascular monitoring technique available in the perioperative medicine setting; it plays a vital role in the assessment of cardiac surgical plans and in anesthetic management [2]. Herein, we report the case of a patient with a malignant extra cardiac tumor that was misdiagnosed as an LA myxoma; in this case, intra-operative TEE played a pivotal role in facilitating the completion of the resection during cardiac surgery. A 3 cm mass or thrombus-like lesion within the LA cavity was detected incidentally, upon chest computed tomography (CT) in a 51-year-old woman (Fig. 1A). A subsequent transthoracic echocardiographic examination (TTE) also revealed the presence of an echogenic mass, with characteristic features of a myxoma in the left atrial appendage (LAA), and concomitant mild mitral valve regurgitation, but normal ejection fraction (59%). An operation, involving median sternotomy under the general anesthesia, including minimally invasive techniques and a cardiopulmonary bypass (CPB), was performed with the aim of resecting the presumed LA myxoma. The anesthetic management proceeded uneventfully, with 0.5% sevoflurane, and