Multimodal imaging of an atypical left atrial myxoma

A 53-year-old man presented with a 12-month history of increasing shortness of breath, decreasing exercise tolerance, peripheral oedema, abdominal distension and paroxysmal nocturnal dyspnoea. He was a previously fit and well man with no co-morbidities. His only cardiac risk factor was of previous tobacco use. On examination, he had signs consistent with biventricular heart failure and a pansystolic murmur. His Brain Natriuretic Peptide (BNP) was raised at 4800. His ECG showed sinus tachycardia, bifid-peaked P waves and incomplete right bundle branch block. Given the history, examination and the raised BNP, he was referred directly for echocardiogram by his general practitioner and a 6 × 5 cm mass was found in his left atrium. The homogenous mass was seen to almost completely fill the left atrial cavity. It obstructed the mitral valve in diastole causing at least …