Right Atrial Myxoma: When a Subtle Neck Vein Sign Reveals a Silent Cardiac Tumour - Dr Satish Javali

Cardiac tumours are among the rarest conditions encountered in clinical practice, and within this group, myxomas are the most common primary tumours of the heart. Even then, the vast majority arise in the left atrium.

Right atrial myxomas account for a small fraction of cases, making them not only rare but also frequently overlooked, especially when symptoms are absent or vague.

A recent case highlights this diagnostic challenge sharply. A young 28-year-old male consulted a physician for a seemingly simple concern: a pulsating vein on his neck. He had no chest pain, breathlessness, palpitations, or fainting episodes.

The general physician, however, recognised that the unusual venous pulsation could indicate altered blood flow on the right side of the heart and advised further evaluation.

Imaging revealed an unexpected and significant finding: an 8-cm right atrial myxoma. The tumour was attached to the interatrial septum and was prolapsing through the tricuspid valve with each heartbeat. Despite its size and location, the patient remained completely asymptomatic, underscoring how silently these tumours can progress.

What Makes Right Atrial Myxomas Tricky?

Right atrial myxomas are rare and often clinically silent, especially in early stages. Their presentation typically depends on whether the tumour obstructs blood flow or interferes with the tricuspid valve. When symptoms occur, they may include:

• Neck vein distension

• Swelling of legs

• Fatigue or reduced exercise tolerance

• Liver congestion

• Sudden breathlessness or collapse if the tumour intermittently blocks blood flow

Because these symptoms mimic common cardiac and non-cardiac conditions, diagnosis is frequently delayed.

Why Early Detection Matters

While benign in nature, myxomas are dangerous due to their mechanical effects. A tumour of this size can:

• Obstruct blood flow from the right atrium to the right ventricle

• Cause arrhythmias

• Lead to pulmonary embolism if fragments dislodge

• Trigger sudden hemodynamic collapse

In this case, early recognition of a subtle physical sign helped prevent potentially life-threatening complications.

Diagnosis and Treatment

Echocardiography remains the primary diagnostic tool, offering clear visualization of the tumour’s size, mobility, and attachment. Additional imaging, such as cardiac MRI or CT scans, can further characterise the mass.

Once identified, the treatment is urgent surgical excision. Surgery involves the complete removal of the tumour and its stalk to prevent recurrence. Outcomes are excellent when the intervention is timely.

A Reminder for Clinicians and the Public

This case reinforces several important lessons:

• Small clinical clues—like a pulsating neck vein—can uncover major underlying conditions.

• Right atrial myxomas, though rare, should be considered when unexplained right-heart signs are present.

• Early diagnosis and prompt surgery offer a complete cure.

Myxomas may be benign tumours, but their silence makes them deceptively dangerous. Careful physical examination and timely imaging can make all the difference, turning an incidental finding into a life-saving diagnosis.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.