Case report.We report the case of a 82-year-old male patient, with a history
of HCV-related cirrhosis and arterial hypertension, in good pharmacological
control. He was admitted to the liver clinic because of fatigue, worsening
ascites and peripheral oedema. Uptitrating diuretic regimen failed in reducing
ascites. Furthermore, before startingbeta-blocker therapy for oesophageal
varices, in order to exclude other comorbidities, the patient was referred to
our cardiology unit for a cardiological assessment. Clinical examination and
ECG were performed. At physical examination an unexpected jugular vein
distension and a right side parasternal diastolic murmur were detected.
These findings appeared not fully related with the plane hypothesis of
worsening portal hypertension. The patient was submitted to transthoracic
echocardiography (TTE): a huge (7.6 x 4.7 cm), echogenic, right atrial mass
was identified; originating from the freewall, the mass filled the whole atrium,
prolapsing through the tricuspid orifice during the entire cardiac cycle. Colour
flow Doppler demonstrated flow aliasing along the mass suggesting
obstruction, while tricuspid continuous wave flow gradient was not
assessable. A dilated inferior vena cava (2.45 cm) with no inspiratory collapse
was detected. These findings led to consider the mass as an unusually-rightsided atrial myxoma. The patient successfully underwent surgical excision. The
histological analysis confirmed the echocardiographic suspect of myxoma.
Discussion. This clinical case showed an uncommon giant, right atrium
myxoma originating from the free wall. Patient’s symptoms were previously
related to his hepatic condition, but a careful physical examination led to
perform a TTE thus allowing to discover the real origin of the clinical signs.
Myxomas are the most common type of primary cardiac tumor in all age groups. Less than 15% occur in the right atrium, usually originating from the interatrial septum, and grow to a significant size before producing symptoms resulting from mechanical interference with blood flow or from pulmonary embolization: an early diagnosis may bethen a challenge. In our case the myxoma grew to such a dimension to obstruct almost all the tricuspid inflow, its symptoms masked by the concomitant liver disease. Just a comprehensive clinical approach pointed out the right clu
