A 69 year old female was admitted at our institution due to recurrent episodes of dizziness. Physical examination revealed a 3/6 diastolic murmur at apex, the rest were otherwise normal. 2D echocardiography revealed a multilobulated cystic mass located in the left atrium, described as "a cluster of grapes", which protrudes in the left ventricular inflow during diastole. A transesophageal as well as a 3D echocardiogram were done to further evaluate the mass. A cardiac CT scan was done to verify presence of any satellite lesions, of which there were none. She also underwent coronary angiography which revealed significant stenosis of the Left Anterior Descending Artery and Left Circumflex Artery. She underwent surgical excision of the left atrial mass along which coronary artery bypass graft. The mass was sent for histologic examination which showed inflammatory myofibroblastic tumor with areas of myxoma. No evidence of malignancy was noted. This is the first reported case of a cystic myxoma in our institution.
Intracardiac masses are rare, benign masses are more common than malignant ones with myxomas being the most common intracardiac mass overall. More commonly, myxomas are located in the left atrium and are usually characterized as irregularly shaped masses. Though cystic presentation of myxomas have been noted in literature, other entities should be entertained such as hydatid cysts, right atrial pseudocysts from peritoneovenous shunts and thrombus cystic changes. Cystic myxomas may contain either serous fluid or hemorrhage. As with all intracardiac masses, symptomatology will depend on location and size of the mass.