https://doi.org/10.4081/monaldi.2023.2768
Role of three-dimensional transesophageal echocardiography in cardiac myxomas: an imaging challenge
Submitted: September 3, 2023
Accepted: September 12, 2023
Published: September 19, 2023
Accepted: September 12, 2023
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Nowadays, the diagnosis of cardiac myxomas (CM), particularly the histological types, remains a challenge. Two-dimensional (2D) transthoracic (TT) and transesophageal (TEE) echocardiography (ECHO) represent the first steps in the imaging pathway. 3D ECHO, implemented in imaging practice, appears to be an emerging diagnostic technique that overcomes some of the limitations of 2D ECHO while integrating the information provided by magnetic resonance (MRI). However, its role in the imaging arena is still debatable. Analyzing 17 myxomas in 13 patients, the study uncovers a diverse anatomical spectrum. Classical CM morphology is a minority, with most myxomas being sessile and originating from unexpected locations (right ventricular outflow tract and left atrial appendage). Texture and size variations are also noted. Comparing imaging, 2D TEE outperforms 2D TT in visualizing anatomical features, especially attachment types. 3D TEE confirms 2D TT findings and offers more detailed assessments, identifying peduncles missed in four cases by 2D TEE. Two small recurrent myxomas were exclusively detected by 3D TEE, not by 2D TEE or MRI. Two patients have papillary myxomas, one has an embolism. Another patient with a solid myxoma also suffers an embolism, with a clot found at the apex during surgery. Our study showed that CM has a wide anatomical spectrum beyond the typical features, making the diagnosis challenging. Therefore, a multimodality imaging approach is essential for distinguishing CM from other cardiac masses and differentiating myxoma histological types. These findings stress the importance of incorporating 3D ECHO alongside other imaging techniques for a comprehensive evaluation.
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How to Cite
Alamro, Bandar, Valeria Pergola, Abdalla Eltayeb, Amal Alshammari, Naji Kholaif, Ahmad Alhamshari, Mohammed Al Admawi, Shamayel Mohammed, Feras Khaliel, and Domenico Galzerano. 2023. “Role of Three-Dimensional Transesophageal Echocardiography in Cardiac Myxomas: An Imaging Challenge”. Monaldi Archives for Chest Disease, September. https://doi.org/10.4081/monaldi.2023.2768.
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