CLINICAL SUMMARYA 37-year-old male initially complained of polyarthralgias, fever and shortness of breath in February of 1986. Physical examination was unremarkable and routine laboratory analysis was unrevealing. The ANA and rheumatoid factor were negative. The sedimentation rate was 62 (elevated), and the C-reactive protein was 7.2 (elevated). The patient was initially thought to have adult onset Still's disease or familial Mediterranean fever. He was started on aspirin and later switched to oral steroids with marginal resolution of symptoms.With the persistence of symptoms, the patient was admitted to a hospital in April. The arthralgias and dyspnea worsened. Past medical and surgical histories were unremarkable. The family, social, and work history were all noncontributory. Physical examination was remarkable for a temperature of 99.6"F, hyperdynamic precordium, with the first heart sound maximally heard at the apex and the second heart sound maximally heard at the base. There was a 3/6 crescendo murmur heard at the apex which radiated toward the axilla, compatible with mitral valve regurgitation. Approximately 0.12 seconds after the second heart sound, a plop, followed by a soft diastolic rumble, was audible. Musculoskeletal exam failed to reveal clubbing, cyanosis, edema or joint swelling. Chest radiographs were remarkable for bilateral small pleural effusions as well as bilateral interstitial infiltrates at the bases. Computed tomography of the chest revealed an interstitial pattern in the lungs. A gallium scan noted diffuse bilateral lung parenchymal uptake.A 2-D echocardiogram revealed a 3.0 X 3.0 cm distal left atrial mass which was attached to the posterior atrial wall above the posterior mitral leaflet. It appeared to prolapse into the valve orifice during diastole.It was felt that the patient had an atrial myxoma, and a thoracotomy was undertaken on April 15, 1986. The atrial mass was identified and resected. The lesion had a pedunculated stalk arising approximately 4.0 mm above the posterior leaflet of the mitral valve annulus. The 0 1992 Wiley-Liss, Inc.