Cardiac myxoma: imaging features in 83 patients

Eighty-six cardiac myxomas were reviewed retrospectively for the clinical, pathologic, and radiologic findings. In this series, 83 patients (47 female and 36 male; age range, 2-78 years; mean age, 48 years) had 49 left atrial (60%), 23 right atrial (28%), seven right ventricular (8%), two biatrial, and two cases of multifocal myxomas. Seventy-one (88%) patients were symptomatic. Radiographs of 38 patients with left atrial myxoma showed evidence of mitral valve obstruction in 53%; radiographs of 16 patients with right atrial myxoma demonstrated calcification and cardiomegaly in 56% and 50%, respectively. Computed tomographic (CT) scans of 21 myxomas demonstrated 20 (95%) spherical or ovoid lesions, 16 (76%) with lobular borders. Seventeen (81%) were hypoattenuated; 14 (67%) were heterogeneous. Twenty-eight magnetic resonance (MR) imaging studies of 30 myxomas showed 29 (97%) spherical or ovoid lesions; 26 (87%) had lobular contours and 26 (90%) of 29 had heterogeneous signal intensity on T1-weighted images. Point of attachment was visible in 15 (83%) cases. Cine gradient recalled echo (GRE) MR images of 10 lesions showed low signal intensity in all cases. Most patients with cardiac myxomas have abnormal but usually nonspecific radiographic findings. CT demonstrates intracavitary heterogeneous, hypoattenuated lobular masses. MR imaging shows heterogeneous lobular lesions and usually allows visualization of the point of attachment. Radiologic imaging of these lesions, particularly with multiplanar and cine GRE MR imaging, can provide accurate assessment of the size, location, and point of attachment of these lesions and should assist in surgical planning.