Retrocardiac textiloma mimicking a left atrium myxoma.

In December 2009, a 79-year-old white man was admitted to the Department of Cardiology for a moderate dyspnea (New York Heart Association II) with breath. His past medical history included a cardiac surgery with double coronary arteries bypass grafting in 1996 and thyroid cancer treated with surgery and radiotherapy. On admission, the physical examination revealed regular heart sounds at 60 bpm, and blood pressure was 100/ 60 mm Hg. No cardiac murmur was heard. Chest x-ray showed a mild cardiomegaly with a retrocardiac mass without pulmonary edema or pleural effusion. The left ventricular (LV) ejection fraction on echocardiography was at 67%. No LV hypertrophy and no LV dilation (LV end-diastolic diameter, 46 mm; index LV end-diastolic diameter, 40 mm/m) were found. The transthoracic echocardiography showed a homogeneous nonmobile mass at the left atrium (LA) level associated with reverberations (Figures 1 to 3 and Movies I and II in the online-only Data Supplement). The transesophageal examination showed the apparently extracardiac mass behind the LA, which seemed to repulse the LA wall (Figure 4). Subsequently, a contrast-enhanced computed tomographic examination of the chest showed a well-defined homogeneous mass (70 64 55 mm) with a soft density (36H), without calcification, gas bubbles, or contrast enhancement, and with what seemed to be an intra-LA (Figure 5). On the sagittal incidence, it seemed that the mass repulsed the LA (Figure 6). There was no evidence of lymphadenopathy, or pleural or pericardial effusion.