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European Journal of Echocardiography Advance Access originally published online on March 14, 2008
European Journal of Echocardiography 2008 9(3):430-432; doi:10.1093/ejechocard/jen026
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Prolapsing left atrial myxoma: preoperative diagnosis using a multimodal imaging approach with magnetic resonance imaging and real-time three-dimensional echocardiography

T. Butz1,2,*, W. Scholtz2, J. Körfer3, A. Maleszka4, S. Jategaonkar2, A. Meissner1, H.J. Trappe1, R. Körfer4, D. Horstkotte2, G. Kleikamp4 and L. Faber2

1 Department of Cardiology and Angiology, Medizinische Klinik II, Ruhr-University Bochum, Hölkeskampring 40, D-44625 Herne, Germany
2 Department of Cardiology, Heart and Diabetes Center North Rhine–Westphalia, Ruhr University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
3 Institute of Radiology, Nuclear Medicine and Molecular Imaging, H eart and Diabetes Center North Rhine–Westphalia, Ruhr University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
4 Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine–Westphalia, Ruhr University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany

Received 20 November 2007; accepted after revision 23 December 2007; online publish-ahead-of-print 14 March 2008.

* Corresponding author. Tel: +49 (0)2323 499 1628; fax: +49 (0)2323 499 360. E-mail address: thomas.butz{at}marienhospital-herne.de


  Abstract

Real-time three-dimensional echocardiography (RT3DE) is a new promising technique for the evaluation of intracardiac masses. We present the diagnostic work-up using a multimodal-imaging approach in a 74-year-old patient with a prolapsing tumour in the left atrium suggestive of a myxoma, causing severe congestive heart failure attributable to dynamic left ventricular inflow obstruction, and mimicking severe mitral valve stenosis. Real-time three-dimensional echocardiography allowed to accurately image the entire volume of the myxoma, and to analyse the dynamic left ventricular inflow obstruction. The size of the lobulated mass as assessed by RT3DE was 65 x 25 x 22 mm.

The mass was surgically removed, histology was diagnostic for myxoma, and the patient had an uneventful recovery.

Real-time three-dimensional echocardiography images the entire volume of a mass allowing for accurate measurements in multiple planes, and allowing for real-time evaluation of obstructive effects on ventricular in- or outflow. This case shows how RT3DE and other non-invasive imaging modalities may be used as complementary techniques for evaluation of intracardiac masses.

Keywords: Myxoma; Three-dimensional echocardiography; Tumour; Thrombus; Magnetic resonance imaging


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