Iceberg rupture: A case of massive right atrial myxoma resulting in pulmonary embolism.

Introduction and importance: This case highlights the importance of echocardiography in diagnosing pulmonary embolism and the need for careful timing of preoperative transesophageal echocardiogram in patients with potentially detachable intracardiac masses as a tumor detachment during TEE led to a life-threatening pulmonary embolism.

Case presentation: A 30-year-old man with a history of treated pulmonary embolism had progressive dyspnea. Tests revealed a mass in the right atrium and a new pulmonary embolism. During preoperative TEE, a free-floating mass disappeared, suggesting embolization. Surgery was immediately initiated, and a myxoma was removed from the right atrium and pulmonary artery.

Discussion: Right atrial myxoma is a rare cause of PE. Routine echocardiography is essential for suspected PE patients. The detachment during TEE may be related to the procedure, handling, or anesthesia. Preoperative TEE can be a useful supplementary diagnostic tool but requires careful consideration of timing.

Conclusion: For pulmonary embolism diagnosis, searching for the cause is important and echocardiography is valuable. For patients with right atrial myxoma and pulmonary embolism, timely diagnosis and surgical resection are necessary, with attention to the timing of preoperative TEE examination.