myxoma is the most common benign cardiac primary tumors , accounting about 50% of cardiac tumors and is more prevalent among females . because of different size of myxomas and their location in the different chambers of heart , patients with atrial myxoma usually present with cardiovascular symptoms such as heart failure and pulmonary hypertension , secondary to mitral valve obstruction . constitutional symptoms of atrial myxoma include weight loss , fatigue , fever , clubbing , anemia , orthopnea , and acute pulmonary edema . on the other hand , myxomas may cause life - threatening cardiac symptoms , e.g. , syncope , requiring emergency surgery . two - dimensional echocardiography is the primary diagnostic imaging , not only as a complement to conventional echocardiography in the assessment of left atrial myxomas but also as a method of differentiating such masses from extra - cardiac tumors compressing the atrium . echocardiography is a helpful method that can determine the tumor size , shape , and mobility . here she dropped during the second prostration in prayer and decreased her mental state , with no prior history of syncope , shortness of breath , or chest pain . she had no significant past medical history , but she had a positive family history of early cardiovascular disease . at presentation , the patient was afebrile and had normal vital signs ( heart rate 80 bpm , blood pressure 110/70 mmhg , oxygen saturation 97% while breathing room air ) and jugular venous pressure ( jvp ) was normal . a 12-lead electrocardiogram revealed normal sinus rhythm with nonspecific minor st - t abnormalities . on cardiac examination , a transthoracic echocardiogram ( tte ) was performed which showed the presence of a pediculated mass in the left atrium , with an appearance suggestive of atrial myxoma , that was prolapsed through the mitral valve towards the left ventricle by changing patient 's position [ figure 1a  c ] . ( a - c ) transthoracic echocardiography : chambers view showing a large mobile left atrial mass prolapsing through mitral valve the patient was referred for urgent surgery . she recovered without major complication and was discharged . at 2-year follow - up , she remains with excellent cardiac function . myxoma is the most common primary benign cardiac tumor . despite the fact that they can be discovered unexpectedly in asymptomatic patients , myxomas usually present with nonspecific signs and symptoms . depending on myxomas locations and their association with the heart structures , they can provide symptoms . tumors that origins from the left atrium , especially if mobile and large , may result in symptoms similar to mitral stenosis due to obstruction of atrio - ventricular blood flow . these symptoms include : exertional dyspnea , paroxysmal nocturnal dyspnea , orthopnea , fatigue , and syncope . in our patient , the tumor plop of myxoma is a protodiastolic murmur that is heard 80 to 150  ms after s2 . tumor plop may be mistaken for an opening snap , and tumor obstruction of the valve leads to a diastolic murmur . the central nervous system ( cns ) symptoms usually call for computed tomography ( ct ) or magnetic resonance imaging ( mri ) scan of the brain to exclude embolization or an aneurysm formation , which is sometimes associated with myxomas . it has been suggested as prudent to perform mri scan of the brain in all cardiac myxoma cases to exclude central nervous system ( cns ) manifestations . in our patient , transthoracic echocardiography reported a mobile and pedunculated mass in the left atrium , which was attached to the interatrial septum . the mass prolapsed into the left ventricle across the mitral valve , resulting in a mitral valve obstruction . recently , the diagnosis of cardiac tumors has improved enormously , and echocardiography has become a choice screening tool for cardiac tumors . the location of the myxoma in the left atrium and its origination from the atrial septum are chief clues for the diagnosis . thus , it is very important to recognize the location of the tumor during echocardiography . as reported in other studies , tte is usually sufficient to make the diagnosis , but if the results are suboptimal , transesophageal echocardiogram ( tee ) should be employed . in conclusion , echocardiography is likely to be a valuable diagnostic tool in patients who have had a cardiac mass . besides , it also offers the cardiologist and cardiovascular surgeon the chance of more accurate pre- and intra - operative assessment of cardiac masses .