An octopus-like myxoma depicted by real-time 3D transesophageal echocardiography.

A 72-year-old woman was admitted for echocardiographic evaluation of a transient ischemic attack that had occurred three weeks earlier. She was hypertensive, in atrial fibrillation, and was receiving chronic anticoagulation therapy, with a good prothrombin time. The transthoracic echocardiogram revealed the presence of a mobile mass located in the left atrium, consistent with left atrial myxoma. The mass protruded into the mitral valve (Figure 1A) without findings of obstruction (Figure 1B; red arrows indicate the signs that correspond to tumor plop). Multiplane transesophageal echocardiography (2D-TEE) was performed in order to identify additional anatomic information about the mass. The tumor was broadly attached to the interatrial septum (Figure 2; green arrows indicate the site of attachment). The use of real-time 3D-TEE allowed the irregular size of the mass to be accurately appreciated, and it became clear that it consisted of two parts. The portion of the mass towards the attachment was a rather homogenous and dense echogenic structure, measuring 1.8 × 2.4 cm, with a multilobular surface and several echolucent areas evenly scattered within it (Figure 3A, blue arrow). The distal portion was composed of a number of irregular and highly mobile papillary excrescences, of gelatinous nature, originating from the central mass, which protruded through the mitral valve during diastole (Figure 3A, red arrow). In addition, the broad attachment to the interatrial septum was confirmed with the use of real-time 3D-TEE (Figure 3B, yellow arrows). The mass was successfully surgically resected, and the histological findings were consistent with a cardiac myxoma.