Endgames Case Report

An intracardiac mass causing shortness of breath

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.f7594 (Published 02 January 2014) Cite this as: BMJ 2014;348:f7594
  1. Clare E Price, foundation year 1 doctor1,
  2. Daniel Keene, core medical trainee 21,
  3. David Hackett, consultant cardiologist1
  1. 1Watford General Hospital, Watford WD18 OHB, UK
  1. Correspondence to: C E Price clareprice{at}gmail.com

A 58 year old woman was admitted with a two week history of progressive shortness of breath and lightheadedness, most noticeable on climbing steep stairs. She denied chest pain or collapse. Her medical history included oesophagitis and hypertension, although she was not taking drugs for either of these problems. Examination was unremarkable—she was haemodynamically stable with a pulse of 85 beats/min, blood pressure 120/85 mm Hg, and respiratory rate 15 breaths/min. Her initial laboratory investigations were normal. Haemoglobin was 127 g/L (reference range 110-153), troponin I less than 0.04 (negative <0.04 µg/L), D-dimer 103 ng/mL (0-230), and brain-type natriuretic peptide 81 ng/L (0-100). Electrocardiography at this time showed left bundle branch block with first degree heart block. She was discharged with arrangements for urgent outpatient echocardiography and 24 hour electrocardiographic monitoring.

Echocardiography was performed one week later and showed an echogenic mass in the left atrium. She was promptly admitted and underwent cardiac surgery, during which a left atrial myxoma was resected. After surgery she reported worsening shortness of breath, with a reduction in her exercise tolerance to 100 yards (90 m) and pre-syncopal episodes.

Questions

  • 1 What is the differential diagnosis of an echogenic intracardiac mass?

  • 2 What are the possible complications of an atrial myxoma?

  • 3 How is an atrial myxoma managed?

  • 4 What could have caused this …

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