Using Computed Tomography Coronary Angiography to Differentiate Atypical Cardiac Myxoma From Thrombus.

Objective: Atypical cardiac myxoma usually presents as an isolated mass attached to the atrial septum on imaging, with no movement and a wider attachment base. It is difficult to distinguish it from cardiac thrombus through conventional echocardiography or computed tomography (CT). The purpose of this study is to evaluate the value of CT coronary angiography imaging features in distinguishing atypical cardiac myxoma from cardiac thrombus.

Materials and methods: This retrospective study included patients with atypical myxoma of the heart confirmed by histopathology (n = 18) and with thrombus disappearance after anticoagulation treatment (n = 23). All patients underwent a third-generation dual-source CT coronary angiography. We compared the clinical features and CT coronary angiography image characteristics of the 2 groups and used maximum-intensity projection and multiplanar reconstruction to show neovascularization of atypical cardiac myxoma.

Results: There are significant differences in the origin, surface, and enhancement patterns between atypical cardiac myxoma and thrombus (P < 0.05, respectively). Specifically, supplied vessels were observed in the atypical cardiac myxoma group, while no neovascularization was detected in the thrombus group (83.33% vs. 0%, P < 0.001).

Conclusions: Noninvasive CT coronary angiography can help distinguish atypical cardiac myxoma and cardiac thrombus through imaging features, especially by detecting the supplying vessels. However, supplementary examinations such as cardiac magnetic resonance imaging are still needed to identify different cardiac tumors.