dic ABC Imagem Cardiovascular Arq Bras Cardiol: Imagem cardiovasc. 2675-312X Sociedade Brasileira de Cardiologia 2675-312X/20213403eabc197 10.47593/2675-312X/20213403eabc197 Images Malignancy of a Benign Tumor A Malignidade de um Tumor Benigno AntunesAndre L 12 PrietoDavid 12 AntunesPedro E 12 Coimbra University Hospital Cardiothoracic Surgery Department Coimbra Portugal Cardiothoracic Surgery Department, Coimbra University Hospital, Coimbra, Portugal. University of Coimbra Faculty of Medicine Coimbra Portugal Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Mailing Address: André L Antunes • Centro Hospitalar e Universitário de Coimbra, Serviço de Cirurgia Cardiotorácica e Transplantação de Orgãos Torácicos, Praceta Mota Pinto, 3004-561 Coimbra, Portugal. E-mail: andre.d.lima.antunes@gmail.com

Conflict of interest

The authors have declared that they have no conflict of interest.

 26 11 2021 2021 34 3 eabc197 17 03 2021 20 03 2021 22 03 2021 This is an open-access article distributed under the terms of the Creative Commons Attribution License Keywords: Atrial Myxoma Cardiac Primary Tumor Pulmonary Vein Invasion Background

Cardiac tumors can be classified into primary and secondary types. Primary tumors are more common, and the majority of them are benign (70%), with myxomas being the most frequent. However, the overall incidence is rare, ranging from 0.15% to 0.2% in autopsy series. Here we present an image of malignancy of a benign tumor.

 Image Case

A 67-year-old man with complaints of tiredness and dyspnea and New York Heart Association class IV heart failure was admitted to our hospital. A physical examination and other tests revealed an atypical finding, and the patient was referred for cardiac surgery.

(A) Chest X-ray showing congestive heart failure. (B) Transthoracic echocardiogram revealing a hyperechogenic mass with irregular contours occupying the entire left atrium and prolapsing to the left ventricle, causing severe mitral stenosis. (C) Transesophageal echocardiogram revealing a huge irregular and heterogenous mass occupying almost the entire left atrium. (D, E) Thoracic computed tomography angiogram (axial and coronal views) showing an irregular hypodense 94 × 68 mm mass occupying almost the entire left atrium and invading the pulmonary veins and showing no enhancement after the injection of intravenous contrast. (F) Operative view of the tumor through the right atrial transeptal approach. (G) Resected specimen whose anatomical pathology was revealed to be a villous atrial myxoma.