A 32-year-old female presented with dyspnea and constant, non-radiating chest pressure along the left sternal border associated with palpitations that started at the gym during her routine workout, with ongoing racing heartbeat after exercise. She had no medical history. She had been taking oral contraceptives for birth control since age 18 (ethinyl estradiol/desogestrel) with no recent changes, and had traveled one-week prior on a flight of 6 h with breaks.
On presentation, she had tachypnea and decreased breath sounds in the right lower lobe. Laboratory results demonstrated a mildly elevated troponin I of 0.18 ng/mL (ref <0.03 ng/mL). CT angiogram chest showed a large embolus in the distal main right pulmonary artery straddling the right upper and lower lobe pulmonary artery divisions; almost completely occluding flow to the segmental arteries (Figure 1). The patient was started on a therapeutic unfractionated heparin. Lower extremity venous Doppler ultrasound was negative for deep vein thrombosis (DVT). Transthoracic echocardiogram (TTE) showed a large, highly mobile mass attached to the right inter-atrial septum (Figure 2) prolapsing through the tricuspid valve in diastole highly suggestive of a cardiac myxoma (Supplemental Video 1).
The patient underwent median sternotomy, right atrial mass resection, repair of atrial septal defect with pericardium, and pulmonary embolectomy (Figure 3). Histologic evaluation of specimens confirmed benign myxoma. The patient was discharged home in stable condition after her surgical procedure and uneventful post-operative course.