Massive atrial myxoma: surgical treatment for an incidentaloma causing dyspnoea.

A patient presented having a one-week history of recurrent falls and confusion and weight loss over an unspecified period of time. A chest radiograph revealed bilateral pleural effusions and the patient was treated for community acquired pneumonia. His weight loss and suspicion of malignant disease prompted computer tomography to be conducted. This revealed widespread mediastinal and oesophageal adenopathy. An echocardiogram showed a large hyperechoic mobile mass. Coronary angiography showed complete occlusion of the left anterior descending and right coronary arteries. He underwent two-vessel coronary artery bypass grafting and an atriotomy to excise the myxoma. He experienced no operative complications and no neurological deterioration and was discharged home three weeks later in sinus rhythm. Myxomas can duplicate a broad array of cardiorespiratory symptoms and signs and can often escape detection by being picked up as an incidentaloma.