Left ventricular myxoma diagnosed by multimodal cardiac imaging with postoperative recurrence: a case report

Left ventricular myxoma is a rare benign cardiac tumour. Diagnosis relies on multimodal imaging, and postoperative recurrence is uncommon. A middle-aged woman with a two-week history of recurrent chest tightness and dyspnoea upon exertion was admitted to our hospital. Transthoracic and transoesophageal echocardiography revealed an irregular, hypoechoic mass (approximately 61 mm × 24 mm) in the left ventricular outflow tract. The mass had a broad base attached to the inferior and posterior walls of the left ventricle, involving the posterior mitral valve leaflet, partial chordae tendineae, and papillary muscles. It exhibited significant deformation and extensive mobility during the cardiac cycle, prolapsing towards the aortic valve orifice during systole and returning to the left ventricular inflow tract during diastole. Cardiac magnetic resonance imaging revealed a mass on the inferior and posterior walls of the left ventricle that involved the posterior mitral leaflet, partial chordae tendineae, and papillary muscles. The mass showed no significant enhancement, suggesting a benign lesion, with myxoma as the primary consideration. Whole-body positron emission tomography/computed tomography revealed a slightly hypodense patchy shadow within the left ventricular cavity adjacent to the mitral valve area, accompanied by calcification and mildly increased fluorodeoxyglucose metabolism. Therefore, malignancy could not be entirely excluded. Owing to the unusual location, extensive involvement, high mobility and deformability of the mass close to the aortic orifice, and the consequent risk of embolism, surgical resection of the cardiac myxoma along with mitral valve replacement was performed. At the six-month postoperative follow-up, tumour recurrence was detected by echocardiography. This case highlights the importance of multimodal cardiac imaging in the diagnosis of left ventricular myxoma, with echocardiography being the most frequently utilised modality. Cardiac magnetic resonance imaging is highly specific for distinguishing between benign and malignant tumours. Echocardiography plays a critical role in the postoperative follow-up of patients with cardiac tumours.