A 17-year-old with cardiac mass and pulmonary embolism

Abstract

A 17-year-old man admitted with recurrent haemoptysis, fever and syncope. He complained about dyspnoea and chest pain since a few weeks. The clinical investigation, ECG and chest X-ray did not show any abnormalities. Laboratory investigations revealed signs of inflammation and increased D-dimer assay. A pulmonary embolism in both lungs with pulmonary infarctions and an intracardial structure in the right atrium were found on the CT-scan of the thorax. The transthoracic and transesophageal echocardiography showed a typical feature of myxoma as a cardiac mass in size of 3.3x3.6 cm in the right atrium attached to the atrial septum. Using cardiopulmonary bypass the tumor excision and the pulmonary embolectomy were performed. The myxoma specimens were histologically detected in the tumor mass as well as in the embolectomy material. The detection of the right atrial myxoma as an uncommon feature of the pulmonary embolism emphasizes the importance of the early echocardiography in the diagnosis of pulmonary embolism.