Thrombus ot mixma - this is the question.

A case report of a woman with multi tumors in the heart atria

Abstract

Introduction: One of the most common tumors of the heart are myxomas and thrombi, which are sometimes difficult to distinguish. The main diagnostic method is echocardiography, and in addition, computed tomography of the heart and cardiac magnetic resonance can be used. We present a clinical case of a female patient with multi tumors in the heart atria. Case report: A 69-year-old female patient presenting with manifestations of heart failure on the background of permanent atrial fibrillation with anticoagulant therapy. Transthoracic echocardiography objectified tumor formations in both atria, initially suspicious for thrombi. During the CT scan of the heart, differences were found in the characteristics of the two formations. The tumor mass in the left atrium (LA) had a heterogeneous appearance, with sharp outlines, attached to the lateral surface of the LA. A hypodense lesion with a lobulated and irregular shape, with a post-contrast density characteristic of blood, was visualized in the right atrium (RA). One of the most definitive evidences for the presence of a myxoma in the LA is the angiographically established additional network of vessels in the same area, probably vascularization of a tumor formation. Surgical extirpation of the tumor masses was performed, with macroscopic characteristics of a myxoma in the LA and a thrombus in the RA. Despite the definite information about the diagnosis from the imaging studies and macroscopic preparations, the histological result is dfferent: a lesion from RA - mixed thrombus and a lesion from LA - thrombus adjacent to cicatricial tissue.

Conclusion: Differential diagnosis of cardiac tumor formations is not an easy task. In certain cases, it is necessary to follow an algorithm of imaging studies in order to support the establishment of the correct diagnosis and the implementation of the appropriate treatment.