Localized constrictive pericarditis due to an intrapericardial myxoma

Abstract

Cardiac myxomas may develop in the left ventricle, left atrium, and right atrium and result in outflow tract obstruction, mitral regurgitation, and congestive heart failure. 1-6 We present images of an intrapericardial myxoma which resulted in localized constrictive pericarditis. A 41-year-old male presented with jugular venous distention and a 2-year history of exertional dyspnea. A transthoracic echocardiogram revealed compression of the right ventricle (RV) by an extracardiac mass (Figure 1). A computed tomography scan showed a calcified, cystic mass in the anterior mediastinum compressing the right ventricle (RV; Figure 2). A magnetic resonance imaging scan demonstrated a 9.1 × 4.2-cm mass in the anterior pericardium with significant compression of the RV free wall resulting in localized constrictive pericarditis (Figures 3A and 3B). At the time of surgery, the mass was excised along with a portion of the anterior pericardium via a mediansternotomy (Figure 4). This resulted in immediate expansion of the RV. The pathology of the mass revealed a myxoid matrix consistent with an intrapericardial myxoma (Figure 5). The patient had an uneventful postoperative course and remains in New York Heart Association Class I 6 months after surgery. CONFLICTS OF INTEREST None declared.FIGURE 1 Echocardiogram demonstrating compression of the right ventricular free wall and an associated mass lesionFIGURE 2 Computed tomography scan revealing a large, anterior calcified pericardial cyst J Card Surg. 2018;33:789-790.wileyonlinelibrary.com/journal/jocs