Recurrent right atrial myxoma presenting as pulmonary hypertension and peripheral pulmonary artery aneurysms

A 55-year-old woman who had undergone open resection of a right atrial myxoma 3 years prior presented with exertional dyspnoea. Transthoracic echocardiography suggested pulmonary hypertension (PH), and CT pulmonary angiography (CTPA) showed a large filling defect obstructing the right upper lobe pulmonary artery (PA), extending into and partially obstructing the right main PA (figure 1A). These findings persisted after 6 months of anticoagulation, raising concern for chronic thromboembolic PH (CTEPH). Repeat CTPA also demonstrated progressive enlargement of multiple contrast-opacified saccular structures associated with peripheral PAs (figure 1B), which had not been present prior to myxoma resection. Right heart catheterisation confirmed mild precapillary PH, and conventional pulmonary angiography confirmed the presence of peripheral PA aneurysms (figure 1C), with the highest burden in the right lower lobe (RLL).