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Updated: Sep 6, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Massive Mural Thrombus Masquerading as Myxoma
Masi Javeed1, Hanan Gruhonjic1, Dveet Patel2
1Internal Medicine, HCA Florida Bayonet Point Hospital, Hudson, USA.
Insights
A massive cardiac thrombus, larger than seven centimeters, mimicked a myxoma in a 75-year-old woman. This symptomatic left atrial mass highlights rare presentations of mural thrombus.
Area of Science:
- Cardiology
- Pathology
Background:
- A 75-year-old female with diabetes, hypertension, and dyslipidemia presented with a three-week history of palpitations.
- Cardiac imaging revealed a large left atrial mass.
- The mass was surgically removed for examination.
Observation:
- Pathological examination identified the mass as a mural thrombus.
- Mural thrombi are common in the left atrium but rarely symptomatic.
- This thrombus was unusually large (over seven centimeters) and presented with symptoms.
Findings:
- The massive mural thrombus mimicked a cardiac myxoma on echocardiography.
- The patient's symptoms were attributed to the large, symptomatic left atrial thrombus.
Implications:
- This case underscores the importance of considering mural thrombus in the differential diagnosis of left atrial masses, especially when symptomatic.
- The unusual size and presentation challenge typical understandings of mural thrombus.
- Accurate diagnosis is crucial for appropriate management and to avoid misdiagnosis as myxoma.
Abstract:
A 75-year-old Caucasian female with a past medical history including insulin-dependent diabetes mellitus, hypertension, and dyslipidemia, presented to the emergency room for having palpitations for three weeks. Echocardiography revealed a very large left atrial mass mimicking myxoma. Mass was excised and examined by pathology, revealing a mural thrombus. A mural thrombus is not an uncommon mass found in the left atrium. However, it does not often present symptomatically, strongly mimics an atrial myxoma on cardiac imaging, and has rarely ever been reported to be greater than seven centimeters in any dimension. We present a case of a 75-year-old Caucasian woman with a massive, symptomatic cardiac thrombus masquerading as a myxoma on imaging.
