Romanović Radoslav, Ratković Nenad, Davičević Žaklina, Ilić Radoje
Vojnosanit Pregl. 2015 Mar;72(3):291-4. doi: 10.2298/vsp140212031r.
Primary heart tumors are extremely rare and myxoma is the most common type of these tumors. Although intra-atrial presentation is a predilection place, right atrial localization is atypical. The symptom triad is characteristic in the clinical presentation of the tumor: embolic complication, intracardiac blood flow obstruction and systemic manifestations like elevated erythrocyte sedimentation rate, fever, anemia, body weight loss.
We presented an elderly female patient with massive myxoma in the right atrium, 77 x 44 mm in diameter, which filled the entire right atrium and spread into the right ventricle, causing the tricuspid valve obstruction and dyspnea. It was visualized by transthoracic echocardiography and small and insignificant pericardial effusion was also seen. After surgical removal of the tumor, the patient remained without any symptoms and pericardial effusion.
Tumors of the right heart have to be considered in the differential diagnosis of unexplained dyspnea in elderly patients. Transthoracic echocardiography is certainly necessary and mostly available diagnostic tool that can be of great help in diagnosing heart tumor as well as planning cardiac surgery, as it provides in most cases excellent visualization of the tumor and its relationship with other parts of the heart.
原发性心脏肿瘤极为罕见，其中黏液瘤是最常见的类型。虽然心房内表现是这些肿瘤的好发部位，但右心房定位并不典型。该肿瘤的临床症状三联征具有特征性：栓塞并发症、心内血流梗阻以及全身表现，如红细胞沉降率升高、发热、贫血、体重减轻。
我们介绍了一位老年女性患者，其右心房有一个巨大黏液瘤，直径77×44毫米，占据了整个右心房并蔓延至右心室，导致三尖瓣梗阻和呼吸困难。经胸超声心动图显示了该肿瘤，还发现少量且无明显意义的心包积液。手术切除肿瘤后，患者未再出现任何症状，心包积液也消失了。
在老年患者不明原因呼吸困难的鉴别诊断中，必须考虑右心肿瘤。经胸超声心动图无疑是必要且大多可获得的诊断工具，它在诊断心脏肿瘤以及规划心脏手术方面有很大帮助，因为在大多数情况下，它能很好地显示肿瘤及其与心脏其他部位的关系。
