Massive left atrial thrombus evades multimodality imaging as a myxoma in a bicaval heart transplant recipient

J Card Surg. 2022 Sep;37(9):2884-2887. doi: 10.1111/jocs.16708. Epub 2022 Jul 5.

Abstract

Intracardiac masses are an extremely rare and poorly described complication following a bicaval heart transplantation. We describe the case of an asymptomatic 62-year-old male with a large left atrial mass found incidentally on transthoracic echocardiography 6 years post-transplant. A battery of additional imaging tests was ordered including transesophageal echocardiography, 18 F-fluorodeoxyglucose positron emission tomography/computed tomography, and T1 and T2 magnetic resonance imaging. Although imaging biomarkers were generally nonspecific, the mass was most consistent with a cardiac myxoma. However, intraoperative findings confirmed by pathology revealed a massive organizing thrombus. The patient had an uneventful recovery after surgical removal of the mass. Our case highlights a very rare phenomenon in heart transplant recipients which remains a unique diagnostic challenge even with current advances in imaging.

Keywords: cardiovascular pathology; transplant.

Publication types

  • Case Reports

MeSH terms

  • Heart Atria / diagnostic imaging
  • Heart Atria / pathology
  • Heart Neoplasms* / complications
  • Heart Neoplasms* / diagnostic imaging
  • Heart Neoplasms* / surgery
  • Heart Transplantation* / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Myxoma* / complications
  • Myxoma* / diagnostic imaging
  • Myxoma* / surgery
  • Thrombosis* / diagnostic imaging
  • Thrombosis* / etiology
  • Thrombosis* / surgery