Two-dimensional echocardiography in the diagnosis of unusual left atrial myxomas

In two patients with atypical myxomas of the left atrium, two-dimensional echocardiography furnished valuable diagnostic information. In one patient, who had previously developed an embolism at the right brachial artery, M-mode echocardiography revealed an abnormal band of echoes within the left atrium. Two-dimensional echocardiography showed a globular cluster of echoes that remained within the left atrial cavity throughout the cardiac cycle; left ventricular angiography confirmed the ultrasonic findings of an intraatrial mass. At surgery, a calcified, nonprolapsing myxoma was excised from the interatrial septum. The second patient had clinical as well as M-mode echographic features of mitral stenosis. Cardiac catheterization showed a significant gradient across the mitral valve, but the left ventriculogram was normal except for an unusual pattern of mitral regurgitation. Subsequent two-dimensional echocardiography revealed a mass of echoes that prolapsed through the mitral valve during diastole. At surgery, a left atrial myxoma was found attached to the posterior mitral annulus. Our experience indicates that two-dimensional ultrasound is superior to conventional echocardiography for detecting unusual cardiac masses.