A 60-year-old woman, Sridevi presents with a murmur suggestive of mitral stenosis and an echocardiography confirmed a mass attached to the fossa ovalis of the left atrial septum. What is the most likely diagnosis?
**Core Concept**
Mitral stenosis is a valvular disorder characterized by the narrowing of the mitral valve opening, which can lead to increased pressure and flow through the left atrium. A mass attached to the fossa ovalis of the left atrial septum suggests a primary cardiac tumor, most commonly a myxoma.
**Why the Correct Answer is Right**
Cardiac myxoma is the most common primary cardiac tumor, accounting for approximately 75% of cases. It typically arises from the interatrial septum, often near the fossa ovalis. Myxomas are benign tumors composed of a mixture of fibroblasts, endothelial cells, and inflammatory cells, embedded in a myxoid matrix. They can cause obstruction of blood flow, leading to symptoms such as dyspnea, fatigue, and palpitations. In Sridevi's case, the echocardiography confirmed a mass attached to the fossa ovalis, making cardiac myxoma the most likely diagnosis.
**Why Each Wrong Option is Incorrect**
**Option A:** Endocarditis is an infection of the heart valves or endocardium, typically caused by bacterial or fungal pathogens. While it can lead to the formation of vegetations, these are usually smaller and more mobile than a myxoma.
**Option B:** Lymphoma is a type of cancer that can involve the heart, but it is less common than primary cardiac tumors like myxoma. Lymphoma would more likely present with systemic symptoms and would not typically form a localized mass.
**Option D:** Metastatic cancer to the heart is more common than primary cardiac tumors, but it is still less likely to present as a localized mass attached to the fossa ovalis.
**Clinical Pearl / High-Yield Fact**
The "pedunculated" nature of cardiac myxomas, with a stalk-like attachment to the septum, is a key characteristic that distinguishes them from other cardiac masses. This feature is often visible on echocardiography.
✓ Correct Answer: A. Cardiac myxoma