Echocardiographic imaging is the initial imaging of choice and has a high sensitivity, specificity,
and overall accuracy (88.9%, 87.8%, and 88.4%, respectively) [5]. Other diagnostic modalities include cardiac CT and MRI. MRI can be beneficial in determining vascularity [6]. Live 3D
echocardiograms can also be used which help provide additional information regarding static and dynamic spatial location of the tumor and also in discerning neighboring structures [7]. Transesophageal echocardiogram should always be performed before surgical intervention for guiding surgical approach [5]. Some of the characteristic echocardiographic findings of PFEs include small size (usually 1.5cm), mobile with a short pedicle or stalk attachment. They are well-circumscribed, homogenous, and sometimes have a speckled interior with stippling near the edges, typically originating from the valvular surface [1, 4, 5]. Compared to PFEs, myxomas are primarily located in the atrium (75% left atrium and 15 − 10% right atrium), are larger, have a heterogeneous appearance, and are attached by a longer stalk to the interatrial septum [8].
Grossly upon resection, the tumor has a sea anemone-like appearance with multiple papillary
fronds. Histopathology shows that they are covered by endothelium with a mucopolysaccharide, and vascular core of connective fiber, which may contain variable content of collagen, smooth
muscle, and elastic fiber [9].
If left untreated, the complications commonly include embolization. If left-sided, they can cause
strokes, and if right-sided, as in our case, they can result in pulmonary embolism and pulmonary
hypertension. Coronary ostial occlusion may be seen in larger-sized or highly mobile masses.
Acute valvular dysfunction may also be seen however, valvular insufficiencies are not commonly seen [5].
Definite management is not agreed upon; surgery is recommended for all patients with prior embolic complications and may be offered to asymptomatic patients
given the risk of embolization. Recurrence after surgery has not been reported. If a patient has a high surgical risk, especially elderly patients, anticoagulation should be considered.