Large Mass in the Left Atrium: The Usual Myxoma or Another Common Etiology?

Published:August 19, 2022DOI:
      A 64-YEAR-OLD, 82-kg, 183-cm man with heart failure with reduced ejection fraction and a remote history of coronary artery bypass graft surgery, mitral valve replacement, left atrial appendage ligation, and chronic atrial fibrillation treated with warfarin presented to the authors’ institution with worsening dyspnea on exertion, fatigue, and orthopnea. He denied chest pain, fever, chills, and palpitations. The physical examination revealed tachycardia and bilateral pitting edema in the lower extremities. A laboratory analysis was notable for markedly elevated N-terminal pro-B-type natriuretic peptide (31,000 pg/mL, normal range <125 pg/mL). The international normalized ratio was increased (1.9). Transthoracic and transesophageal echocardiography (TEE) examinations were performed as part of the diagnostic evaluation, and the images were obtained (Fig. 1, 2, 3; Videos 1, 2, 3). What was the diagnosis?
      Fig 1
      Fig 1Midesophageal 5-chamber transesophageal echocardiography view.
      Fig 2
      Fig 2Midesophageal bicaval transesophageal echocardiography view.
      Fig 3
      Fig 3Apical 4-chamber transthoracic view; the red arrows demonstrate tracts from the pulmonary veins to the mitral valve.

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