Atrial myxoma: an unusual aetiology for exertional dyspnoea and palpitation.

Gutierrez O, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-223341 Description A 67-year-old woman had recently emigrated from the Dominican Republic where, many years prior, she had been evaluated for ‘tachycardias’ and had unrevealing monitors. She was well until 6 months prior to admission when she started to experience unpredictable, generally exertional palpitations, dyspnoea and left arm discomfort. There was no history of antecedent anxiety. Examination was notable for a 3/6 systolic murmur heard from apex to base and radiating to the neck that ultimately decreased with Valsalva manoeuvre, consistent with aortic sclerosis that was also seen on her echocardiogram. ECG showed normal sinus rhythm, significant left ventricular hypertrophy with strain and question of a right atrial abnormality. Transthoracic echo, for the murmur, showed a 3 cm highly mobile atrial mass, sometimes crossing the mitral valve, and aortic sclerosis (online supplementary video 1). Catheterisation showed unremarkable coronary arteries and no vascular attachments to the mass. Cardiac MRI showed a large mobile and multilobulated mass in the left atrium which did not have any resting perfusion (figure 1) or late gadolinium enhancement and was called a thrombus. However, her atrial contribution to filling was excellent (figure 2); thus, thrombosis was excluded. The patient proceeded to surgery.