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Cardiovascular Images
May 27, 2020

A Woman in Her 50s With Dyspnea, Palpitation, and Severely Elevated Pulmonary Artery Pressure

Author Affiliations
  • 1Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
JAMA Cardiol. 2020;5(7):842. doi:10.1001/jamacardio.2020.1048

What is the cause of this patient’s elevated pulmonary artery systolic pressure on echocardiography (Figure, A)? A woman in her 50s was admitted for a 2-week history of dyspnea and palpitation. Her physical examination results were unremarkable. Her blood test results, including thyroid function, were also unremarkable. The chest radiography results showed lung congestion and the electrocardiogram noted sinus tachycardia. A computed tomography scan of the thorax demonstrated a left atrial mass suspected to be an intracardiac thrombus. (Figure, B) On echocardiogram, the left atrial mass was attaching to the atrial septum, and no mass was seen in the atrial appendage (Figure, A). It obstructed the mitral valve opening and caused severe pulmonary hypertension, with a pulmonary artery systolic pressure of 100 mm Hg. The most likely clinical diagnosis was a left atrial myxoma.1 The patient received an emergency tumor resection, and its size was 8 × 5 × 4 cm. Histology results confirmed the diagnosis of cardiac myxoma. The patient had an uneventful recovery. A repeated echocardiogram 1 week later showed resolution of pulmonary hypertension and all valvular abnormalities.