A woman felt what she thought was a shove inexplicably bring her to her knees. After experiencing no other symptoms for a year, a mysterious pain on the left side of her body prompted her doctor to order an ultrasound. It revealed a mass roughly the size of a golf ball in her chest, Lisa Sanders writes for the New York Times Magazine.

Expedite patient diagnosis

'I still feel fine'

One afternoon, a 67-year-old woman was at a hair appointment when she suddenly felt what she described as a shove that caused her to lose her balance as she walked across the salon. Moments later, she felt a shove again—this time, sending her up against a doorway before falling to her knees.

The woman's hairdresser helped her up and asked if she was okay. "I guess so," the woman replied. However, she knew she had not felt okay in those brief moments.

A few weeks later, the woman visited her primary care doctor, Rajiv Jana, for her annual physical. At the visit, she tried to describe her experience at the salon.

Jana was not sure what could have caused her symptoms. But once he learned the woman hadn't experienced symptoms since leaving the salon, his concern dissipated.

The woman pressed Jana, asking if he thought she had a stroke. Jana asked, "You felt completely fine afterward? No weakness anywhere?"

"Completely fine," she replied. "I still feel fine. I work in my garden and ride my bike every day. Nothing has changed."

"Then I don't think it was a stroke," Jana told her. "Let me know if it happens again."

The woman had no cause to visit Jana again until the following year. She went to his office for a leg infection that she got in her garden. She had taken antibiotics and was healing well, Sanders writes.

"Anything else?" Jana asked after he finished examining her leg. She told him she had a mysterious pain in her left side for the past few months that did not seem to be a strained muscle.

To determine the cause of the woman's pain, Jana sent her for an ultrasound.

'There might be something inside your heart'

Two days later, when the patient was on the way home from her ultrasound, her phone rang. "Are you at home?" Jana asked. "I'm still driving, but tell me anyway," she responded.

"The scan shows that there might be something inside your heart," Jana replied. Jana explained that the mass could be a blood clot or a tumor and told her she needed to see a cardiologist and get a CT scan.

That weekend, the woman was still noticeably upset when she ran into a friend, named Sandi, at a funeral. "I think I need a cardiologist," the woman told Sandi. When she explained what her doctor told her earlier that week, Sandi recommended a cardiologist named Ricci Minella.

Later that evening, the woman received a call from Minella, who told her to come to the University of Pittsburgh Medical Center Shadyside first thing Monday morning to have the mass evaluated.

After meeting with the patient, Minella told the woman that another ultrasound was needed to better look at the mass.

Minella confirmed there was a mass that appeared to be roughly the size of a golf ball tethered to the right side of the woman's heart by a narrow string, Sanders writes. The mass looked like a benign tumor, called a myxoma, Minella added. While the mass was not a cancer, it needed to be removed.

Myxomas can cause obstructions in the heart. When someone has a myxoma on the left side of their heart, the mass is pushed toward the valve that separates the atrium from the ventricle each time the heart beats. If the mass somehow blocks that valve, blood can't get through.

According to Minella, this is likely what happened to the woman during her hair appointment. "That episode was most likely caused by this sudden loss of blood flow to the brain," Sanders writes. "And when she stumbled, she jostled the mass out of the valve, and the blood flow resumed."

"The myxoma looked as if it was just the right size to block that opening. She was lucky it hadn't happened more often," Sanders adds.

Too busy enjoying life to worry

Three days later, the woman was taken into surgery to have the tumor removed. "The surgeon had to cut her chest wide open from neck to the bottom of her sternum," Sanders notes. "Only then could he safely remove the tumor."

While the patient was not able to ride her bike or work in her garden during her monthslong recovery, she told Sanders that she now feels great. 

However, "[i]t is still hard for her to imagine that she could have something so large and so dangerous in her heart and not even know it," Sanders adds.

Notably, Minella said he didn't think that the pain the woman experienced leading up to the initial ultrasound was related to the tumor.

"So what would have happened if she hadn't gotten that ultrasound?" Sanders wonders.

While the woman said she was initially worried about that thought, she told Sanders that she "finds that she is too busy enjoying her life to worry anymore." (Sanders, New York Times Magazine, 7/13)