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A transthoracic echocardiography in an 83-year-old woman revealed a thickening of the intra-atrial septum/mass in the LA (A). Further diagnostic via transesophageal echocardiography confirmed a 15 × 14 × 14 mm ball-shaped echo-inhomogeneous left-atrial mass originating from the intra-atrial septum without infiltration of adjacent structures (Panels C and D). Worm-like anechoic structures beside echo-dense areas and color-Doppler evaluation suggested blood vessels (Panel B). Intravenous SonoVue (Bracco Imaging) echo contrast agent was applied. It showed distribution from the right heart (E2) to the left atrium, initially sparing the intra-atrial septum mass (E3), before it adapted its echogenicity to the left atrial blood pool (E4)(Movie in data supplement).
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Application of contrast agent allowed to rule out the differential diagnosis of an atrial thrombus, as only perfused tissue demonstrates uptake of contrast agent. Hence, diagnosis of left atrial myxoma was established. The good vascularization was later also demonstrated by coronary angiography. Due to her age and lack of clinical symptoms, the patient opted against surgery and for a watch-and-wait approach, as informed consent.
This examination should once again exemplify the value of contrast echocardiography - an image modality that in our opinion is too rarely used - as a low-threshold means to exclude relevant differential diagnoses and set the right path for the patient.
Declarations
Competing interests
The authors declare no competing interests.
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