Cardiac myxoma: a contemporary multimodality imaging review

Cardiac myxoma (CM) is by far the most common primary benign cardiac tumor, typically arising in the left atrium with an attachment point in the fossa ovalis region. Although the etiology of CM remains unclear, we know that this endocardial-based mass originates from undifferentiated mesenchymal cells. Continuous technical improvements in the field of echocardiography since the 1960s has profoundly changed the diagnostic approach by allowing a good tumor detection as well as the preoperative planning by providing crucial information concerning the attachment point location. However, echocardiography has its limitations among which lack of tissue characterization and restricted field of view can arise diagnosis difficulties in atypical presentations. With the widespread and routine use of echocardiography and chest computed tomography (CT), incidental detection of CM is not infrequent. As a consequence, it has become mandatory for cardiologists and radiologists evolving in a multimodality imaging world to be familiar with the wide range of presentations of this tumor. The authors present here a review of the common and less common aspects of CM using the main imaging modalities available: echocardiography, cardiovascular magnetic resonance imaging, CT, positron emission tomography and coronary angiography.