A Giant Right Atrial Myxoma with Lung Carcinoma Detected by Syncope / 日本心臓血管外科学会雑誌

ABSTRACT

A 75-year-old man was referred to our hospital with dyspnea on effort, recurrent attacks of loss of consciousness and abnormal shadow on chest X-ray film. Computed tomographic scan confirmed a 1.5×2.0cm mass with slight spiculation in the right lower lobe (S6) and revealed an ovoid right atrial mass. Transthoracic echocardiography showed that the giant mass which filled most of the right atrium had no mobility. Coronary angiography revealed clusters of new vessels which originated from the atrial branches of the circumflex coronary artery. A T1-weighted MRI scan demonstrated that the mass was isointense relative to the adjacent myocardium. We considered that performing cardiac surgery prior to pulmonary resection, as in a staged procedure, would have advantages in morbidity. We first performed removal of the right atrial tumor which was a 6.8×5.5×4.5cm shiny mass attached to the interatrial septum. Histological examination of the mass confirmed the diagnosis of cardiac myxoma. Three months later, right S⁶ segmentectomy was carried out using thoracoscopy and the tumor was finally diagnosed as squamous cell carcinoma. We have followed the patient for about 10 months after the first operation and there is no evidence of tumor recurrence and no more syncopic attacks.