Introduction: Cardiac tumors are extremely rare tumors. The most common cardiac tumors are myxomas located in the atria, they usually have a stalk and are attached to the interatrial septum. Tumors located in the appendage of the left atrium are extremely rare and they are most often myxomas. (1, 2)

Case report: 85-year-old patient was admitted to the cardiac intensive care unit due to pulmonary edema caused by acute coronary syndrome. Coronary angiography revealed multivessel coronary disease with left main affection and significant coronary disease of all three coronary arteries. The initial cardiac ultrasound verifies degenerative valves disease with a reduced left ventricle ejection fraction. Considering the findings of the coronary angiography and cardiac ultrasound, it was decided to present the patient to the heart team. A control ultrasound shows at the beginning of the left atrial appendage an isoechoic oval formation measuring 1.3 cm x 1.2 cm, which seems to be fixed to the myocardium and without visible flotation (Figure 1). An MSCT of the heart verifies a 45x15x13mm oval tumor formation, which is attached to the lateral part of the atrium wall by its base, and protrudes into the lumen of the left atrium. The radiological characteristics of the solid mass corresponded to a myxoma (Figure 2). The patient refused any interventional treatment. Hospitalization was complicated by the development of a stroke and the patient died. The autopsy was not performed due to the clear cause of death and at the request of the patient’s family so the PHD finding of this tumor mass is missing.

Conclusion: Serial performance of cardiac ultrasound is extremely important when monitoring patients in the cardiac intensive care unit. Atypical projections in standard cardiac ultrasounds can be of significant importance and can provide us with additional diagnostic value. A detailed approach to performing an ultrasound of the heart enables a correct diagnosis and the overall treatment of the patient.