Case Of the Week (COW) 29 Dec 2013
Answer:
ATYPICAL LEFT ATRIAL MYXOMA.
Findings:
Relatively immobile well circumscribed T1 and T2 hypointense lesion with peripheral rim calcification is noted attached to the superior aspect of the interatrial septum (left atrial aspect) and protruding into the left atrium. The lesion had soft tissue attenuation value in CT with only moderate contrast enhancement. Concentric left ventricular hypertrophywas also noted.
Discussion:
The Clinical Indication for Cardiovascular MR Examination was for Assessment of left atrial immobile mass in Echocardiography -? Lipomatous Hypertrophy of Interatrial septum /?Myxoma. The above MRI features were consistent with mass lesion, Most likely Left Atrial Myxoma with calcification . Histopathology also confirmed the same. Normally Myxomas are hyperintense in T2W1 due to myxomatous component .T2 hypointensity may be related to a fbrous component or calcificaion. the major differential diagnosis for the above patient would be a Thrombus,which is distinguished from Myxoma by its low signal in T2-TSE and relative immobility. However the mild contrast enhancement helped in characterizing this lesios as a Myxoma. Myxomas are pedunculated, mobile, and attached at the left (78%) or right (11%) interatrial septum. The MR imaging appearance of cardiac myxomas varies depending on the amount of myxomatous and fibrous tissue. Myxomas show increased T2 signal because of the myxomatous components of the tumor and show heterogenous enhancement
Contributed By:
Dr. Babu Peter MD, DNB
Associate Professor, Barnard Institute of Radiology
Senior Consultant Radiologist, Aarthi Scans, Chennai
Answer:
ATYPICAL LEFT ATRIAL MYXOMA.
Findings:
Relatively immobile well circumscribed T1 and T2 hypointense lesion with peripheral rim calcification is noted attached to the superior aspect of the interatrial septum (left atrial aspect) and protruding into the left atrium. The lesion had soft tissue attenuation value in CT with only moderate contrast enhancement. Concentric left ventricular hypertrophywas also noted.
Discussion:
The Clinical Indication for Cardiovascular MR Examination was for Assessment of left atrial immobile mass in Echocardiography -? Lipomatous Hypertrophy of Interatrial septum /?Myxoma. The above MRI features were consistent with mass lesion, Most likely Left Atrial Myxoma with calcification . Histopathology also confirmed the same. Normally Myxomas are hyperintense in T2W1 due to myxomatous component .T2 hypointensity may be related to a fbrous component or calcificaion. the major differential diagnosis for the above patient would be a Thrombus,which is distinguished from Myxoma by its low signal in T2-TSE and relative immobility. However the mild contrast enhancement helped in characterizing this lesios as a Myxoma. Myxomas are pedunculated, mobile, and attached at the left (78%) or right (11%) interatrial septum. The MR imaging appearance of cardiac myxomas varies depending on the amount of myxomatous and fibrous tissue. Myxomas show increased T2 signal because of the myxomatous components of the tumor and show heterogenous enhancement
Contributed By:
Dr. Babu Peter MD, DNB
Associate Professor, Barnard Institute of Radiology
Senior Consultant Radiologist, Aarthi Scans, Chennai