Cardiac myxoma with high standardized uptake value of FDG-PET-CT in the right ventricular outflow tract

Background: Cardiac myxoma rarely occurs in the right ventricle, and as is a benign disease, it rarely shows high positivity on 18F fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT).

Case presentation: We present herein the case of a 77-year-old woman who was found to have a heart murmur during a routine health checkup. Further examination revealed a 27-mm tumor in the right ventricular outflow tract (RVOT) and moderate aortic valve stenosis. Additionally, during her preoperative evaluation, she was diagnosed with a 10-mm tumor in the right breast, prompting her referral to our hospital for further evaluation and treatment. Contrast-enhanced CT and magnetic resonance imaging of the chest did not show signs strongly suggestive of malignancy, nor did echocardiography. However, FDG-PET/CT showed an abnormally high standardized uptake value (SUV) max of 9.91. Based on these findings, we decided the best treatment course was tumor resection of the RVOT and aortic valve replacement. Our intraoperative examination confirmed a tumor inferior to the pulmonary valve; therefore, we resected three branches of the septal artery feeding the tumor, including part of the right ventricular free wall. A rapid pathological examination indicated a benign tumor, and the patient's final diagnosis was a cardiac myxoma. The postoperative course was uneventful, and to date, workup including CT scans during follow-up has shown no obvious recurrence.

Conclusion: This case highlights the challenges and importance of accurate imaging diagnoses in cardiac tumors. The patient underwent a successful surgical resection of the cardiac myxoma, emphasizing the need for careful postoperative follow-up.