Left atrial appendage myxoma: ‘the elephant's trunk’!
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* K T Sajeer
* G Rajesh
* M N Krishnan

A 72-year-old lady presented with history of recurrent episodes of syncope. Examination revealed a mid-diastolic murmur at apex. Electrocardiogram showed left atrial enlargement. Chest X-ray was normal. Transthoracic echocardiography showed a mobile left atrial mass of mixed echogenicity (see online supplementary video 1). Transoesophageal echocardiography confirmed a 60×30 mm, broad-based, pedunculated mass arising from left atrial appendage, resembling an ‘elephant's trunk’ prolapsing through the mitral valve to the left ventricle during each diastole (figure 1, see online supplementary video 2). The mass was surgically excised. Histopathology was consistent with cardiac myxoma.

![Figure 1](http://heartasia.bmj.com/https://heartasia.bmj.com/content/heartasia/5/1/81/F1.medium.gif)

[Figure 1](http://heartasia.bmj.com/content/5/1/81/F1)

Figure 1 
(A) Transoesophageal echocardiography, mid-oesophageal two chamber view, showing myxoma arising from left atrial appendage resembling the trunk of an elephant (B). The peduncle is broader, when it arises from the left atrial appendage, when compared with the narrow base when myxoma arises from the interatrial septum.

## Footnotes

*   Contributors KTS: substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. GR: drafting the article or revising it critically for important intellectual content. MNK: final approval of the version to be published.

*   Competing interests None.

*   Patient consent Obtained.

*   Provenance and peer review Not commissioned; internally peer reviewed.