Introduction
Although rare, cardiac myxoma (CM) represents the most common benign primary cardiac tumor[1]. Many patients are asymptomatic and CM is often an incidental finding[2]. Potentially life-threatening complications such as tumor obstruction or embolization can occur, making accurate diagnosis crucial [3,4]. However, diagnosis is challenging due to the broad differential diagnosis of CM, which includes other cardiac tumors and cardiac masses such as thrombi, vegetations, calcific lesions, and other rare conditions.
Transthoracic echocardiography (TTE) nowadays represents the most commonly used initial imaging modality in the diagnostic workup of CM. It provides information on tumor size, location, attachment point, morphology, mobility, and its relation to surrounding structures. The majority of CM are located in the left atrium, attached to the atrial septum in the region of the fossa ovalis. These are considered as typical CM, but atypical localizations outside the left atrium have been described in around 30% [5]. Size and appearance (solid and round or polypoid) may also vary considerably in CM [6].
TTE has an excellent detection rate for CM and a sensitivity of 90–96% in diagnosing CM has been reported [4]. However, the heterogeneous morphological presentation leads to overlap with other cardiac masses and may affect the specificity and accuracy of TTE in CM diagnosis. Furthermore, TTE lacks tissue characterization [7]. Multimodality cardiac imaging ensures a more detailed analysis. Ultimately, the final diagnosis is made by histopathological examination of the excised tumor [8].
The aim of our single-center study was to evaluate the utility and accuracy of TTE in the diagnosis of CM and to determine echocardiographic characteristics indicative of pathohistologically confirmed CM.