Obstetrics, Neonatology, Cardiology, Cardiac Imaging, and Cardiac Surgery
A right atrial tumor, characterized by transthoracic echocardiography in image 1 appears to have a stalk like one might expect for an atrial myxoma. The authors quickly involved the obstetrical and neonatology who decided to promptly deliver a healthy baby. Involvement by other clinical services usually results in more optimal outcomes as they understand their “area” best. Given the unusual location as well as shape they quite correctly involved their imaging experts (after delivery of the child) for further delineation of structure. Collaboration with imaging specialists is crucial in the diagnosis and planning treatment of cardiac tumors, especially when question arises regarding origin or extent. Improved understanding by collaboration with the imaging experts is gained even in “simple” cases and is highly recommended. The surgical resection was “radical” but unfortunately despite this, the patient developed a local recurrence despite adjuvant chemotherapy. Additional imaging in this case continued to show features atypical for myxoma. While the authors chose primary surgical resection, biopsy and neoadjuvant chemotherapy once malignancy is diagnosed is another option. There is evidence of improved outcome with neoadjuvant chemotherapy (2) and even microscopic residual tumor is associated with reduced survival (3). However, knowledge regarding this is scarce and collaboration with colleagues, both local and international is required to answer such questions more completely (4). Interesting, early work on local tumor margins are one example of attempts to improve resection (5).