Received: 17 January 2002 Revised: 12 July 2002 Accepted: 29 July 2002 Published online: 25 October 2002 © Springer-Verlag 2002 Abstract A case of a right-sided gi- ant cardiac myxoma with malignant transformation of glandular struc- tures causing systemic metastases is described. Plain chest radiography and computed tomography localized the tumor within the heart. Exact depiction of the origin of the tumor using subtracted 2D-projection MR angiography is documented. Radio- logic findings and differential diag- nosis of this unique tumor are dis- cussed. Keywords Giant cardiac myxoma · Glandular structures · Tumor · CT · MR angiography Eur Radiol (2003) 13:2099–2102 DOI 10.1007/s00330-002-1663-0 CARDIAC Boris P. Eckhardt Corina C. Dommann-Scherrer Gerd Stuckmann Christoph L. Zollikofer Klaus U. Wentz Giant cardiac myxoma with malignant transformed glandular structures Introduction Cardiac myxomas are the most common primary heart tumors which arise mostly in the left atrium. Diagnosis is usually established by echocardiography and MRI. These benign neoplasms are composed of an abundant myxoid matrix and stellate tumor cells often clustering around capillaries. Rarely benign glandular structures may be included the presence of which is explained by embryonal development. In this report we describe a unique case of a malignant transformation of glandular structures in a right-sided myxoma leading to local infil- tration of the atrial wall and systemic metastases. Case report A 61-year-old woman presented with acute right and left heart failure. On the posteroanterior chest radiograph (Fig. 1a) a nearly symmetrical bilateral enlargement of the heart contour without specific chamber enlargement was seen. Several large calcified areas were depicted within the cardiac silhouette without the as- pect of a circumscribed tumor. The lateral view (Fig. 1b) showed a large, more circumscribed mass. This mass which formed the pos- terior and inferior border of the heart contained extensive amor- phous calcifications and was suspected to arise from the right atri- um. Signs of right heart congestion with atelectasis of the lower lobes and pleural effusion were also recognizable. Nonenhanced CT (Fig. 2) showed extensive densely calcified areas in a large right cardiac tumor. With MRI the tumor could be distinguished from the left ven- tricular myocardium as well as the pericardium (Fig. 3a). The right ventricular myocardium was displaced but not invaded B.P. Eckhardt · G. Stuckmann C.L. Zollikofer · K.U. Wentz ( ✉ ) Institute of Radiology, Cantonal Hospital, Brauerstrasse 15, 8401 Winterthur, Switzerland e-mail: ku.wentz@ksw.ch Tel.: +41-52-2664610 Fax: +41-52-2664509 C.C. Dommann-Scherrer Insitute of Pathology, Cantonal Hospital, Brauerstrasse 15, 8401 Winterthur, Switzerland K.U. Wentz Medical Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany