Left atrial myxoma — difficulties in diagnosis, determination of treatment tactics in an older patient: clinical case

BACKGROUND: Myxoma is one of the most common benign neoplasms of the heart. The most characteristic localization is the inter-atrial septum in the region of the oval window. Clinically, myxoma can be represented by obstructive, thromboembolic, non-specific symptoms. However, the absence of pathognomonic signs is the reason for the late diagnosis and treatment.

CLINICAL CASE DESCRIPTION: A 78-year-old female patient was hospitalized at the department of cardiology for examination, correction of therapy, and determination of indications for diagnostic coronary angiography. During a routine examination, echocardiographic data revealed a formation in the left atrial (LA) cavity. To clarify the diagnosis and determine the treatment strategies, the patient underwent magnetic resonance imaging of the heart with gadolinium, which verified this formation as an LA myxoma measuring 10×12 mm. Considering the age of the patient, the presence of concomitant pathology, and absence of complications of myoxoma (obstructive and thromboembolic), the patient was further observed.

CONCLUSION: LA myxomas have clinical manifestations; however, quite often, they are accidental findings in echocardiographic studies. Surgical removal of the tumor is currently the main treatment method. The absolute indications for surgical treatment are large tumors and presence of complications (embolic and obstructive). However, in older patients, who, according to imaging methods, have small tumors and concomitant somatic diseases, dynamic follow-up appears suitable to assess the progression of tumor growth and determine the timing of surgical treatment.