Prolapsing left atrial myxoma: preoperative diagnosis using a multimodal imaging approach with magnetic resonance imaging and real-time three-dimensional echocardiography

Real-time three-dimensional echocardiography (RT3DE) is a newpromising technique for the evaluation of intracardiac masses.We present the diagnostic work-up using a multimodal-imagingapproach in a 74-year-old patient with a prolapsing tumour inthe left atrium suggestive of a myxoma, causing severe congestiveheart failure attributable to dynamic left ventricular inflowobstruction, and mimicking severe mitral valve stenosis. Real-timethree-dimensional echocardiography allowed to accurately imagethe entire volume of the myxoma, and to analyse the dynamicleft ventricular inflow obstruction. The size of the lobulatedmass as assessed by RT3DE was 65 x 25 x 22 mm. The mass was surgically removed, histology was diagnostic formyxoma, and the patient had an uneventful recovery. Real-time three-dimensional echocardiography images the entirevolume of a mass allowing for accurate measurements in multipleplanes, and allowing for real-time evaluation of obstructiveeffects on ventricular in- or outflow. This case shows how RT3DEand other non-invasive imaging modalities may be used as complementarytechniques for evaluation of intracardiac masses.