CTICasesRight Atrial Myxoma with Atypical MRI Characteristics
Imaging findings
A large right atrial mass is present, bulging into the IVC but not originating from it. On MRI, the mass shows low T1 signal pre-contrast and remarkably bright T2-weighted signal (described as 'like a light bulb'). Perfusion imaging demonstrated slow, progressive enhancement, continuing to perfuse up to 25 minutes after contrast administration. An outside CT revealed punctate calcifications within the mass (thought to be phleboliths). Pathology confirmed it as a classic right atrial myxoma, largely composed of myxoid elements, explaining the T2 intensity. The mass originated from the lateral wall, sparing the septum.
Key takeaways
This case highlights an atypical MRI presentation of a right atrial myxoma, which mimicked a hemangioma due to its extreme T2 brightness and slow, progressive enhancement. Despite these unusual features, common things are common, and pathology confirmed it to be a myxoma. Right atrial myxomas frequently do not involve the septum, unlike their left-sided counterparts. The abundant myxoid elements within the tumor contribute to the high T2 signal intensity.
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