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Cardiac Myxoma CMR — EECC MCQ

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EasyCardiac ImagingCardiac Myxoma CMREECC

A 60-year-old man with suspected cardiac tumour undergoes CMR. A large mass is seen in the left atrium attached to the interatrial septum by a narrow stalk. The mass is heterogeneous with areas of haemorrhage on T1 and T2 sequences. What is the most likely diagnosis?

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Correct answer: D — Cardiac myxoma — the most common primary cardiac tumour in adults; typically arises from the interatrial septum on a pedunculated stalk, most commonly in the left atrium

Cardiac myxoma is the most common primary cardiac tumour (50% of all primary cardiac tumours). Classic features: (1) left atrium (75%), right atrium (20%), ventricles (5%); (2) arises from the interatrial septum (fossa ovalis) on a narrow pedunculated stalk; (3) heterogeneous appearance on CMR (variable signal on T1/T2 due to haemorrhage, calcification, and cystic degeneration); (4) characteristic mobility. Clinical presentations include: constitutional symptoms (fever, weight loss, elevated ESR — due to IL-6 production), embolic events (stroke, peripheral embolism — from friable tumour fragments), and obstructive symptoms (mimicking mitral stenosis if the mass obstructs the mitral orifice). Surgical excision is curative with low recurrence (<5% for sporadic; higher for familial — Carney complex).

Reference: EACVI Cardiac Masses Guidelines