Right atrial myxoma. Unusual presentation with cyanosis and clubbing

The clinical, laboratory and operative findings in a forty-nine year old woman with a right atrial myxoma are described. The patient presented with hepatomegaly, cyanosis and clubbing of unknown etiology. Cardiac catheterization and angiocardiography established the correct diagnosis of right atrial myxoma and demonstrated a right to left shunt at the atrial level. With the patient under total cardiopulmonary bypass, the tumor, associated right atrial wall and interatrial septum were successfully resected, and the interatrial septum and atrial wall were reconstructed. The varied and often perplexing clinical presentations of right atrial myomas are emphasized. The findings in four other patients with right atrial myxomas and associated right to left shunts described in the literature are also summarized.