A novel approach for a novel combination: a trans-septal biopsy of left atrial mass in recurrent phyllodes tumour

A 69-year-old female with a previous hemisternectomy for recurrent phyllodes tumour was referred for echocardiography because of progressive dyspnoea, orthopnea, and a diastolic mitral rumble on auscultation. Transthoracic echocardiography revealed a large left atrial mass. Although a diagnosis of myxoma was likely, there was concern that this was a cardiac metastasis. A tissue diagnosis was mandatory before further thoracic surgery could be considered. This was obtained via a trans-septal puncture using transoesophageal echocardiographic guidance. Histology confirmed a diagnosis of myxoma, and our patient underwent successful surgery. This case highlights the importance of obtaining accurate tissue diagnosis and of excluding metastatic disease in patients with a cardiac mass and a history of tumour, prior to deciding whether surgical excision is warranted.