There is no big deal in presenting a usual, common myxoma [Figure 1]. The nonhomogenous mass is wandering through the left atrium even though it is attached to the fossa ovalis, while the mitral valve plays pinball with the myxoma in order to avoid systemic embolization [Video 1] . Unfortunately, the mitral valve lost the game, and the patient - a 100-year-old hypertensive woman with no other remarkable features, presented to our emergency department (ED) in a state of coma.
Figure 1: A common left atrial myxoma as described in text
As I said, there is nothing peculiar about the case itself, but I'd like to point out some specific features regarding how the mass was discovered.
The ED physician asked for cardiac ultrasound examination after computed tomography (CT) demonstration of a large ischemic area of the brain. Even though the indication for performing cardiac ultrasound is appropriate,  the exam will never subvert the essential management of a 100-year old patient. Life comes to and end, and we can't help about it. The patient died shortly after the exam. I guess that handheld echocardiography would have been the first choice in this specific case.
I performed this echocardiogram many years ago, in 2006 and I clearly remember it was rush-hour with some added difficulties: No ECG tracing in order to hurry up, and no video cassette recorder (VCR) recording. The video was created from an animated .gif file that I created putting together three pictures, and it needed just a bit of editing for aesthetic purposes. To date, there is a call for action towards echo lab digitalization to overcome all the aforementioned difficulties, even though we started talking about the topic in 1997 , and the results are a bit discouraging.
Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al. American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria For Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol 2011;57:1126-66.