Left atrial appendage myxoma: ‘the elephant's trunk’!

Abstract

A 72-year-old lady presented with history of recurrent episodes of syncope. Examination revealed a mid-diastolic murmur at apex. Electrocardiogram showed left atrial enlargement. Chest X-ray was normal. Transthoracic echocardiography showed a mobile left atrial mass of mixed echogenicity (see online supplementary video 1). Transoesophageal echocardiography confirmed a 60×30 mm, broad-based, pedunculated mass arising from left atrial appendage, resembling an 'elephant's trunk' prolapsing through the mitral valve to the left ventricle during each diastole (figure 1, see online supplementary video 2). The mass was surgically excised. Histopathology was consistent with cardiac myxoma.

Left atrial appendage mass

“…On imaging, a myxoma appears globular or spherical, with a friable surface and heterogeneous internal echogenicity . The presence of a mobile mass attached to the endocardial surface by a stalk favors the diagnosis of cardiac myxoma, although for myxomas originating within the body of the LAA, a broader base seems more typical …”

“…6 The presence of a mobile mass attached to the endocardial surface by a stalk favors the diagnosis of cardiac myxoma, although for myxomas originating within the body of the LAA, a broader base seems more typical. 7 The papillary fibroelastoma (PFE) is a differential for a LA tumor.…”