We present the case of a 62-year-old-woman with intermittent "burning" chest pain without any other symptoms. Physical exam was normal. Initial complementary tests such as electrocardiogram and chest X-ray were normal. Transthoracic echocardiography showed a pediculated mass with "snake-like" motion inside the left atrium and trans-esophageal echocardiogram (TEE) was ordered. 2D and 3D TEE demonstrated a bi-lobulated, 2- fingered and mobile mass attached to the inter-atrial septum. Because de unusual morphology of the mass, atrial myxoma and thrombus-in-transit were proposed as possible diagnoses and anticoagulant therapy was started. Cardiac magnetic resonance was performed to get a better characterization of the tissue and revealed high signal intensity of the mass on T1-T2-weighted images. Late enhancement sequences after gadolinium injection showed hyper-intense heterogeneous mass, consistent with the diagnosis of myxoma and after surgery, pathological examination showed a hypo cellular myxoid matrix rich in proteoglycans with a mucous stroma and groups of cells forming nest and cord confirming the diagnosis.
Conclusion: This case illustrates de usefulness of a multimodality approach for establishing a prompt diagnosis and management of an extremely rare morphology of myxoma named "myxoma medusa".