{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T07:35:05Z","timestamp":1762068905879,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T00:00:00Z","timestamp":1665187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Myxomas are slowly growing benign neoplasms which are rare in children. Up to 80% can be located in the left atrium and generate symptoms such as embolism, cardiac failure, fever and weight loss. Rarely, myxomas can be detected in the right ventricle outflow tract, causing arrhythmias, pulmonary emboli and sudden death. We report the case of a 13-year-old healthy child brought to the Emergency Department (ED) of the Children\u2019s Hospital Bambino Ges\u00f9, Rome, for recent dyspnea, chest pain on exertion and new onset cardiac murmur. Patient underwent medical examination and echocardiogram with the finding of a rounded and lobulated voluminous mass in the right ventricle outflow tract (RVOT) which caused severe obstruction. The contrast computed tomography (CT) scan confirmed the presence of a heterogeneously enhancing soft-tissue mass occupying the RVOT with no evidence of pulmonary embolization. The mass was surgically excised, and the pathologic examination confirmed our suspicion of myxoma. Our experience suggests that myxoma can have mild clinical symptoms, the presentation may be non-specific, and diagnosis can be a challenge Careful examination and a diagnostic imaging workup, primarily with the transthoracic echocardiogram, are needful to make a rapid differential diagnosis and to better manage surgical treatment and follow-up.<\/jats:p>","DOI":"10.3390\/ijerph191912888","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T22:19:27Z","timestamp":1665267567000},"page":"12888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["New Onset Cardiac Murmur and Exertional Dyspnea in an Apparently Healthy Child: A Rare Localization of Obstructive Myxoma in the Right Ventricle Outflow Tract without Pulmonary Embolization\u2014A Case Report and Literature Review"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0004-6490","authenticated-orcid":false,"given":"Carolina","family":"D\u2019Anna","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9120-0424","authenticated-orcid":false,"given":"Alberto","family":"Villani","sequence":"additional","affiliation":[{"name":"Department of Emergency, Admission and General Pediatrics, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Ammirati","sequence":"additional","affiliation":[{"name":"Department of Emergency, Admission and General Pediatrics, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9047-2383","authenticated-orcid":false,"given":"Paola","family":"Francalanci","sequence":"additional","affiliation":[{"name":"Department of Pathological Anatomy, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Ragni","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Cecconi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2611-8061","authenticated-orcid":false,"given":"Aurelio","family":"Secinaro","sequence":"additional","affiliation":[{"name":"Advanced Cardiovascular Imaging Unit, Department of Imaging, IRCCS Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Chinali","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Santilli","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Guccione","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Galletti","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Brancaccio","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,8]]},"reference":[{"key":"ref_1","first-page":"1027","article-title":"Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies","volume":"117","author":"Lam","year":"1993","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_2","first-page":"1252","article-title":"Metastases of the heart and pericardium","volume":"27","author":"Silvestri","year":"1997","journal-title":"G. Ital. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1055\/s-2007-1014064","article-title":"Primary cardiac tumors: Experience at the University of Minnesota","volume":"38","author":"Molina","year":"1990","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/S1010-7940(02)00592-4","article-title":"Cardiac myxomas: 24 years of experience in 49 patients","volume":"22","author":"Keeling","year":"2002","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1586\/14779072.2015.1024108","article-title":"Current diagnosis and management of cardiac myxomas","volume":"13","author":"Jain","year":"2015","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/0735-1097(95)80031-B","article-title":"Diagnosis and management of fetal cardiac tumors: A multicenter experience and review of published reports","volume":"26","author":"Holley","year":"1995","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1067\/mje.2001.114627","article-title":"Differential diagnosis of intracavitary tumors obstructing the right ventricular outflow tract","volume":"14","author":"Gopal","year":"2001","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1067\/mhj.2000.107176","article-title":"Histopathologic and clinical characterization of cardiac myxoma: Review of 53 cases from a single institution","volume":"140","author":"Pucci","year":"2000","journal-title":"Am. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/S0022-5223(00)70223-6","article-title":"Expression of vascular endothelial growth factor and angiogenesis in cardiac myxoma: A study of fifteen patients","volume":"119","author":"Kono","year":"2000","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1053\/ct.2000.5080","article-title":"Unusual primary tumors of the heart","volume":"12","year":"2000","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.carpath.2007.01.001","article-title":"Large left atrial myxoma presented as fever of unknown origin: A challenging diagnosis and a review of the literature","volume":"16","author":"Gavrielatos","year":"2007","journal-title":"Cardiovasc. Pathol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/j.1600-0404.2005.00413.x","article-title":"Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: A case report and review","volume":"111","author":"Sabolek","year":"2005","journal-title":"Acta Neurol. Scand."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/00005792-200105000-00002","article-title":"Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases","volume":"80","author":"Pinede","year":"2001","journal-title":"Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1056\/NEJM199512143332407","article-title":"Cardiac myxomas","volume":"333","author":"Reynen","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1016\/j.ijcard.2007.01.008","article-title":"A rare case of multiple right heart myxomas","volume":"118","author":"Attar","year":"2007","journal-title":"Int. J. Cardiol."},{"key":"ref_16","first-page":"49","article-title":"Right ventricular myxoma mimicking recurrent pulmonary embolism after primary ligament reconstruction","volume":"26","author":"Zuber","year":"1997","journal-title":"VASA Z. Gefasskrankh."},{"key":"ref_17","first-page":"1006","article-title":"Carney Complex: The complex of myxoma, spotty, pigmentation, endocrine over activity and shwannomas","volume":"63","author":"Carney","year":"1989","journal-title":"Semin. Dermotal. Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/S0003-4975(98)00591-8","article-title":"Surgical experience with intracardiac myxomas: Long-term follow-up","volume":"66","author":"Bhan","year":"1998","journal-title":"Ann. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.amjsurg.2003.08.004","article-title":"Surgical outcome in 85 patients with primary cardiac tumors","volume":"186","author":"Bakaeen","year":"2003","journal-title":"Am. J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"178","DOI":"10.2459\/JCM.0b013e3281ac22cb","article-title":"Atrial myxoma: A 25-year single-institutional follow-up study","volume":"9","author":"Catania","year":"2008","journal-title":"J. Cardiovasc. Med."},{"key":"ref_21","first-page":"215","article-title":"Cardiac myxoma: Its origin and tumor characteristics","volume":"9","author":"Amano","year":"2003","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_22","first-page":"2256","article-title":"Right ventricular myxoma with near obstruction of the pulmonary artery","volume":"41","author":"Tatebayashi","year":"1993","journal-title":"Zasshi J. Nihon Kyobu Geka Gakkai"},{"key":"ref_23","first-page":"51","article-title":"Myxoma of the right ventricle: Report of a clinical case and review of the literature","volume":"57","author":"Guadarrama","year":"1987","journal-title":"Arch. Inst. Cardiol. Mex."},{"key":"ref_24","first-page":"268","article-title":"Photoclinic. Right ventricular myxoma presenting as pulmonary embolism","volume":"10","author":"Behzadnia","year":"2007","journal-title":"Arch. Iran. Med."},{"key":"ref_25","first-page":"241","article-title":"Pulmonary embolisation of right-sided intracardiac masses\u2013report of two cases","volume":"44","author":"Singh","year":"1992","journal-title":"Indian Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/0167-5273(84)90150-5","article-title":"Right ventricular myxoma","volume":"5","author":"Boulafendis","year":"1984","journal-title":"Int. J. Cardiol."},{"key":"ref_27","first-page":"609","article-title":"Myxoma of the right ventricle revealed by repeated pulmonary embolisms","volume":"64","author":"Vernant","year":"1971","journal-title":"Arch. Des Mal. Du Coeur Et Des Vaiss."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4103\/1995-705X.182642","article-title":"Sporadic multicentric right atrial and right ventricular myxoma presenting as acute pulmonary thromboembolism","volume":"17","author":"Singh","year":"2016","journal-title":"Heart Views"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.acvd.2010.08.004","article-title":"A biatrial myxoma revealed by pulmonary embolism","volume":"104","author":"Doguet","year":"2011","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1001\/jama.1965.03090040050019","article-title":"Right atrial myxoma complicated by a thrombus","volume":"193","author":"Holdswade","year":"1965","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e18386","DOI":"10.1097\/MD.0000000000018386","article-title":"Pulmonary embolism as the initial manifestation of right atrial myxoma: A case report and review of the literature","volume":"98","author":"Ma","year":"2019","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/1752-1947-8-134","article-title":"Recurrent right ventricular cardiac myxoma in a patient with Carney complex: A case report","volume":"8","author":"Sardar","year":"2014","journal-title":"J. Med. Case Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s40119-018-0109-y","article-title":"Pulmonary Embolism Following Incomplete Surgical Resection of a Right Ventricular Myxoma: A Case Report and Review of the Literature","volume":"7","author":"Assaf","year":"2018","journal-title":"Cardiol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.ijcard.2004.02.019","article-title":"Second recurrence of cardiac myxoma in a young patient. A case report","volume":"101","author":"Moyssakis","year":"2005","journal-title":"Int. J. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1136\/heart.84.6.652","article-title":"Images in cardiology: Recurrent myxoma of the right ventricle","volume":"84","author":"Segal","year":"2000","journal-title":"Heart"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1186\/1752-1947-8-435","article-title":"Right ventricular myxoma obstructing the right ventricular outflow tract: A case report","volume":"8","author":"Gribaa","year":"2014","journal-title":"J. Med. Case Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/0002-9343(80)90455-6","article-title":"Massive pulmonary embolism associated with a right ventricular myxoma","volume":"69","author":"Gonzalez","year":"1980","journal-title":"Am. J. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12888\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:48:22Z","timestamp":1760143702000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,8]]},"references-count":37,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph191912888"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191912888","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,10,8]]}}}