Introduction: Primary cardiac tumours are rare with an autopsy frequency of only 0.001-0.03%, they represent an important group of cardiovascular abnormalities. Atrial myxoma is the most common primary cardiac tumor. In about 20% cases, myxomas are asymptomatic and are discovered as an incidental finding. (1-3) Echocardiography is an ideal initial imaging modality since it is simple, non-invasive, widely available, and low cost. Patients with atrial myxoma typically present with, cardiovascular symptoms such as heart failure and mitral valve obstruction. They can also present with neurologic deficits or systemic symptoms. We report case of asymptomatic cardiac myxoma in patient with non-Hodgkin lymphoma, which were diagnosed by means of transthoracic echocardiography (TTE).

Case presentation: 72-year-old man presented in echocardiography laboratory to assess left ventricular systolic function in preparation for hematological treatment, immunochemotherapy, previously diagnosed lymphoma non-Hodgkin B mantle cell. He was asymptomatic, and specifically denied chest pain, dyspnea, palpitation, and syncope. TTE verified mobile cardiac mass in the left atrium, which protrude into the left ventricle during diastole. Transesophageal echocardiography (TEE) confirmed the existence of the cardiac mass, overall dimensions 2.1x3.9 cm, which pushes the posterior mitral leaflet, and consequently causes a mild mitral regurgitation (Figure 1). The patient underwent cardiac surgery, and cardiac masses was removed. Pathologic examination confirmed: large mass 4x4x2 cm, myxsoma. Histological mass of built of myxoid structures without significant atypia, the mass was found some bleeding and fibrin. Control TTE after surgey, showed a non-dilated left atrium, without significant mitral regurgitation. The patient is still under the control of hematologists, plans to initiate further haematological treatment.

Conclusion: Echocardiography represent the most commonly used and accurate diagnostic tool for the diagnosis of cardiac myxomas. TEE provides very useful information, and is superior to TTE in fully demonstrating the relationship between cardiac mass and the cavity wall, and also for the planning of surgery. Periodic echocardiographic control is necessary to detect possible recurrence myxoma.