Case Report:
A previously well 44-year old woman was reviewed in the emergency department for systemic malaise, night sweats and altered bowel habits for 4 weeks, weight loss of approximately 5 kgs over the last 5 weeks with a CT abdomen ordered by her General Practitioner a day prior to the admission. Additionally, she noted an unaccustomed lethargy for 8 months, possibly longer. Her background was non-contributory. She was not on any regular medications and had no known allergies to any medications. Her family history was not significant. There was no history of recent overseas travel. She is a non-smoker and has alcohol on a social basis.

Her physical examination was unremarkable. Her ECG and chest x-ray was unremarkable. Laboratory tests of note were haemoglobin of 99g/L (115-165g/L),Platelet count of 481x10E/L (150-400x10E/L), ESR of 101mm/h (0-15), CRP of 52mg/L (0-8). The WBC including MCV and differential count were normal. Serum electrophoresis showed the alpha 2 fraction was elevated with a mild diffuse increase in the gamma region, ANA: 1:80 with a speckled pattern, which was homogenous and the centromere & nucleolar pattern, were negative. The rheumatoid factor was normal. Mid stream urine including culture, three fecal specimens and sputum specimens for Mycobacteria and other pathogens were negative. The Mantoux test did not show any induration. She also had normal cervical, chlamydia and high vaginal swabs. She also had a normal CEA, CA-125 and gynecological cytology.

The CT abdomen did not show any intra-abdominal pathology but the top cuts demonstrated a small pericardial effusion. A transthoracic echocardiogram (TTE) done on day 2 of her admission, showed a heterogenous mass measuring 2.2 x 2.2 cms in the region of the fossa ovalis characteristic of a left atrial myxoma. A transoesophageal echocardiogram (TOE) on day 3 confirmed the TTE findings. There was no stalk noted (Figure 1). Other investigations completed were CT chest and coronary angiography, both of which were normal. She had surgical resection which confirmed a myxoma attached to roof of left atrium over an area approximating a 5-cent coin (approximately 2cms) with no stalk. The patient was reviewed in the cardiology outpatient department and is doing well.