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Admitted to the hospital following a collapse at home. History of weight loss and general decline. Cachectic in appearance. Atrial fibrillation and raised D-dimer on admission. Concerns over underlying malignancy and pulmonary embolism.
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There is good opacification of the pulmonary arterial tree with no evidence of pulmonary embolus. There is no evidence of right heart strain. There is a polypoidal soft tissue filling defect within the anterior aspect of the left atrium, apparently arising from the intra-atrial septum via a pedicle, in keeping with an atrial myxoma. There is bibasal patchy atelectasis and small bilateral pleural effusions.
The principal differentials for a mass within one of the heart chambers are myxoma and thrombus, particularly within the left atrium where thrombus occurs most frequently, usually in a background of atrial fibrillation.
Further imaging with MRI can differentiate tumor from thrombus. Myxomas arise from the atrial wall via a pedicle, most commonly from the inter-atrial septum, protruding into the atrial cavity. Myxomas are of heterogenous appearance with low-to-intermediate T1w signal and intermediate-to-high T2w signal. Thrombi are usually of homogenous appearance, although they may appear more heterogenous when chronic and organized. Myxomas demonstrate patchy and heterogenous poor enhancement with gadolinium, whereas thrombi do not enhance.
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