Primary cardiac tumors are extremely rare, and hemangiomas represent only a small subset, with right atrial involvement being particularly uncommon, posing diagnostic challenges due to non-specific symptoms and overlapping imaging features. We present a 55-year-old male with an incidentally discovered right atrial mass initially suspected to be a myxoma. Multimodal imaging with transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) was performed: TTE identified a large mobile mass causing partial tricuspid obstruction, while CMR with quantitative diffusion-weighted imaging/apparent diffusion coefficient (DWI/ADC) provided detailed tissue characterization and anatomical mapping, revealing typical features of a hemangioma. Surgical resection was performed via median sternotomy under cardiopulmonary bypass. The mass, arising from the right atrial posterior wall and interatrial septum, was completely excised, and the atrial defect was repaired with a pericardial patch. Histopathology and immunohistochemistry confirmed a benign capillary hemangioma. Postoperative echocardiography demonstrated reduced right atrial diameter, resolution of obstruction, and mild stable tricuspid regurgitation, with no major complications. Combined TTE and CMR multimodal imaging is crucial for accurate preoperative diagnosis and surgical planning of right atrial hemangiomas. Complete surgical resection achieves favorable outcomes, and long-term multimodal imaging follow-up is recommended to exclude recurrence.

Left atrial myxoma is the most common primary cardiac tumor, although intratumoral hemorrhage remains exceedingly rare. We recently treated a 55-year-old man with a 37-year smoking history who presented with progressive dyspnea and leg edema caused by acute heart failure. Echocardiography revealed a large, pedunculated left atrial mass (54 × 27 mm) protruding into the left ventricle during diastole, causing functional mitral stenosis, as well as moderate mitral and tricuspid regurgitation. Contrast-enhanced computed tomography revealed a 30 × 46 mm intracardiac mass without definite feeding vessels or signs of hemorrhage. The patient underwent semi-urgent surgery 1 week after diagnosis, with complete tumor excision and concomitant mitral and tricuspid annuloplasty. Histopathological examination revealed a 5.5 cm myxoid tumor containing multiple intratumoral hemorrhagic foci with hemosiderin deposition, consistent with hemorrhagic myxoma. The postoperative course was uneventful. Intratumoral bleeding within a myxoma may result from rupture of fragile neovessels, potentially leading to sudden enlargement and mitral inflow obstruction. Awareness of this rare condition is essential for timely clinical recognition and appropriate surgical decision-making in patients with deteriorating left atrial myxoma.

Cardiac myxoma is the most common primary cardiac tumor and typically arises in the left atrium. Large, mobile myxomas may prolapse through the mitral valve and produce functional mitral stenosis with secondary pulmonary hypertension. We report a 57-year-old woman with cardiovascular risk factors (hypercholesterolemia and obesity) who presented with New York Heart Association class III dyspnea and palpitations. First-line transthoracic echocardiography revealed a giant, mobile left atrial mass (4.7 x 4.8 cm) attached to the basal third of the interatrial septum, prolapsing into the left ventricle and producing a mean transmitral gradient of 16 mmHg with severe pulmonary hypertension (estimated pulmonary artery systolic pressure approximately 80 mmHg). Preoperative coronary computed tomography (CT) angiography, performed to exclude significant coronary artery disease given her cardiovascular risk factors and to characterize the intracardiac mass non-invasively, confirmed the mass and showed coronary atheromatosis without significant stenosis. The mass was surgically resected within two weeks of diagnosis via a minimally invasive thoracoscopic approach, decided in a multidisciplinary heart team meeting, with femoro-femoral cannulation, without preoperative anticoagulation; activity restriction and close clinical monitoring were maintained while awaiting surgery. The postoperative course was uncomplicated, with early extubation and rapid mobilization. At one-month follow-up, the transmitral gradient and pulmonary artery pressures had normalized, with a stable, mild residual mitral regurgitation and complete symptom resolution. Histopathological examination showed a well-circumscribed, non-encapsulated, smooth-surfaced proliferation of spindle-to-stellate cells within an abundant myxoid stroma, without atypia, mitoses, or necrosis; immunohistochemistry was positive for calretinin, confirming the diagnosis of myxoma. This case illustrates the diagnostic and hemodynamic impact of a giant left atrial myxoma and the feasibility of a minimally invasive thoracoscopic resection in a carefully selected patient.

This report elaborates on a unique case of multiple cerebral lesions from completely resected atrial myxoma which was treated with craniotomy and radiotherapy. A 56-year-old female presented with progressive headache, left limb weakness and low-grade fever for over 20 days. She had undergone total resection of left atrial myxoma nine months before. MRI revealed multiple hemorrhagic lesions in both cerebral hemispheres and left cerebellum. The symptomatic lesion in the right parietal lobe was resected under neuronavigation, ultrasound and electrophysiological monitoring. Pathology confirmed myxoma seeding. Whole-brain radiotherapy (30 Gy in 15 fractions) was administered for the remaining multiple lesions. During 14 months of follow-up, the patient's left limb muscle strength improved from grade V[-] to grade V, MRI showed no disease progression, and Karnofsky Performance Status (KPS) increased from 70 preoperatively to 90. One epileptic seizure was well controlled with medication.

This case study reports on a 43-year-old man with a history of mitral and aortic valve replacements, who presented with worsening dyspnea, palpitations, chest pain, and vertigo. Despite stable vital signs and fluoroscopy, imaging revealed large, mobile masses near the mitral valve, likely indicating left atrial myxomas causing mechanical obstruction. Urgent CT scans ruled out embolism, and surgical intervention was performed, revealing two sizable tumoral masses attached to the left atrium. Preoperative coronary angiography showed normal coronary arteries. This case underscores the importance of comprehensive diagnostic evaluation and a multidisciplinary approach in managing complex cardiac conditions, particularly in patients with previous valve replacements.

Takayasu arteritis (TA) is a form of vasculitis that primarily affects the large arteries of the body. Involvement of the coronary arteries is uncommon, whereas cardiac myxomas are benign growths within the heart that can cause problems by embolization or by obstruction. Both diseases are rare, and coexistence of both is exceptionally uncommon. An 84-year-old man with a 30-year history of TA (type V) on low-dose prednisone and weekly methotrexate was found to have a large left atrial myxoma in addition to diffuse coronary aneurysms on routine follow-up. The increased inflammatory markers, erythrocyte sedimentation rate (ESR) 52 mm/h and C-reactive protein (CRP) 18 mg/L, and magnetic resonance imaging (MRI) of the thoracic aorta (wall thickening with mural enhancement of the ascending aorta and arch) confirmed active vasculitis. His modified National Institutes of Health (NIH) score was 5 (active TA). Echocardiography revealed a mass, measuring 3.5 × 3.0 cm in size, arising from the left atrium. The mass caused mild mitral inflow obstruction resulting in a mean transmitral gradient of 3.5 mmHg across the valve and mild to moderate regurgitation. The estimated pulmonary artery pressure was mildly elevated at 34 mmHg. The patient was, however, asymptomatic and had a good functional status. The coronary arteries were significantly dilated. The left anterior descending (LAD) artery was chronically occluded, and the right coronary artery (RCA) was dilated, forming a huge aneurysm. Given the patient's age, any surgical approach would be associated with prohibitive risk. Thus, management of the coronary artery abnormalities in this patient with active TA consisted of immunosuppressive therapy, anticoagulation, and guideline-directed medical therapy (GDMT) for hyperlipidemia. This case highlights the importance of a comprehensive inflammatory and hemodynamic assessment of the patient with TA before any surgical intervention can be considered. In an elderly patient with active disease and in stable hemodynamic condition, even a large, mobile atrial myxoma with mild hemodynamic impact may be managed conservatively with anticoagulation and close surveillance when surgical risk is prohibitive.