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Cardiology

A Woman With Recurrent Syncope and Malar Flush in the Setting of a Left Atrial Echogenic Mass

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1 Credit CME

JAMA Cardiology

Published Online: April 26, 2023

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Article Information and Disclosures

Zhenyu Dong, MD, PhD^1,2;

Yanmei Lu, MD, PhD^1,2;

Baopeng Tang, MD, PhD^1,2

Author Affiliations

¹Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
²Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China

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A middle-aged woman was admitted to the hospital due to syncope. According to results of the auscultation, the woman was initially diagnosed as having mitral stenosis after detection of a mid-diastolic, low-pitched, rumbling murmur and an audible opening snap at the apex. The patient also exhibited malar flush, which is a common skin manifestation in patients with mitral stenosis¹; this finding further supported our diagnosis (Figure, A). However, an echogenic mass, measuring 32 × 28 mm (Figure, B), was detected in the left atrium by transthoracic echocardiography. The mass was connected to the intertribal septum via a short flap, prolapsing across the mitral valve into the left ventricle and causing transient obstruction of blood flow (Video). The opening snap and diastolic murmur were actually the result of movement of the myxomatous tumor and obstruction of the valve, respectively.² The patient was then referred for surgical resection. Pathology confirmed a diagnosis of myxoma.

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Article Information

Published Online: April 26, 2023. doi:10.1001/jamacardio.2023.0727

Corresponding Authors: Yanmei Lu, MD, PhD (gracy@189.cn), and Baopeng Tang, MD, PhD (tangbaopeng1111@163.com), Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, South Liyushan Road, Xinshi Zone, Urumqi 830054, China.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was funded in part by grants 81660071, 81860081 from the National Natural Science Foundation and grant 2022TSYCCX0101 from Provincial Top Young Scientific and Technological Talents of Tianshan Talent Cultivation Program.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the patient for granting permission to publish this information.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.