Embolic atrial myxoma causing aortic and carotid occlusion

doi:10.1016/j.surneu.2007.07.062

Surgical Neurology

Volume 71, Issue 2, February 2009, Pages 246-249

https://doi.org/10.1016/j.surneu.2007.07.062 Get rights and content

Abstract

Background

Cardiac myxomas are a rare but well-described cause of stroke that usually occur in young people. Cardiac myxoma can embolize to multiple sites throughout the body.

Case Description

A 45-year-old woman presented acutely with altered mental status and signs of lower extremity vascular occlusion. Pathologic studies confirmed the diagnosis of cardiac myxoma.

Conclusions

This is the first case reported in the English literature of simultaneous aortic and internal carotid artery occlusion from embolism of an atrial myxoma without evidence of intracardiac tumor on transesophageal echocardiogram.

Introduction

Cardiac myxomas are an uncommon but well-described cause of peripheral embolization and stroke in younger individuals. Cardiac myxomas are the most common benign tumor of the heart in adults and represent approximately 83% of primary cardiac tumors, whereas rhabdomyomas are more common in children [7]. Cardiac myxomas arise from the endocardium and can occur in any of the cardiac chambers, but up to 75% to 80% occur in the left atrium, near the fossa ovalis [2], [5], [7], [10], [12]. The mean age of presentation has been reported between 30 and 70 years [1], [2], [5], [11]. There is a female-to-male predominance of between 3:2 and 2:1 [5], [10]. The classic triad of presenting symptoms includes (1) obstructive cardiac signs, (2) embolic signs, and (3) constitutional or systemic manifestations. Nearly 50% of patients with embolic cardiac myxoma present with neurologic sequelae as a result of cerebral ischemia and, less commonly, hemorrhage [2]; however, cardiac myxoma occurs in only 0.5% of stroke patients, with women in the fifth decade at greatest risk [3].

Section snippets

Case report

A 45-year-old woman presented to the emergency department after collapsing in the cab of her husband's semitrailer truck. She had no antecedent trauma, and her medical history was unremarkable. On examination, she was lethargic and confused but reportedly did not have focal neurologic findings. Her skin was mottled below the umbilicus, and her femoral pulses were absent. The result of her laboratory evaluation was normal. The initial computed tomography (CT) imaging of the head was negative for

Discussion

Cardiac myxomas most commonly arise in the left atrium (80%), with 15% to 20% occurring in the right atrium, and 4% in the ventricles; approximately 5% of patients have multiple myxomas [11]. In a retrospective review of 112 patients by Pinede et al [10], the authors found that the most common initial presenting symptoms of atrial myxoma were related to mitral valve obstruction; however, 33 patients presented with signs of embolism, including 24 to the central nervous system. Ekinci and Donnan

Acknowledgments

The authors thank Kristin Kraus for her editorial assistance in preparing the manuscript.

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Myxomas are tumors that occur due to uncontrolled proliferation of mesenchymal cells. Cardiac myxomas although very rare, are still the most common primary tumor of heart. Cardiac myxomas have a prevalence of 0.03% in the general population. They can have a variety of clinical presentations with obstructive cardiac symptoms, constitutional symptoms and symptoms due to embolism to other body parts chief among them. CNS embolism with stroke is among the rarest clinical presentation of cardiac myxomas. Our article portrays a case of cardiac myxomas that initially resulted in episodes of dyspnea and syncope and eventually led to recurrent episodes of transient ischemic attack and stroke. Case was confirmed by transesophageal echocardiography and managed surgically by medial sternotomy. Myxoma, a benign primary cardiac tumor is itself a rare occurrence, embolization of myxoma leading to multiple strokes is an atypical clinical presentation. Our report would be a valuable addition to the already existing literature.
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Citation Excerpt :
Summated data are presented as numbers and percentages. One hundred twenty-six published cases of cardiac myxoma were identified [3–125]. Not all data elements were reported in every case.
Patients with occult, undiagnosed cardiac myxomas (CM) often present with acute complications that mimic other, more common, conditions. We describe two recently encountered patients who classically demonstrate this phenomenon and report the results of an integrative review of CM cases to define the characteristics of such patients.
A comprehensive 20-year review of reported cases that described patient-specific data of CM was performed. Using a standardized tool, the following elements were collected: age; gender; presenting symptoms and signs; diagnostic and management approaches; and outcomes.
One hundred twenty-six cases of CM were identified. The mean patient age was 47.5 years (range, 6-90). Seventy (56%) were women. The most common mimic conditions initially being considered were cardiac complications, including acutely decompensated heart failure, myocardial infarction, dysrhythmia and sudden death (46%); systemic embolization, including cutaneous infarction and pulmonary embolism (23%); central nervous system embolization, including transient ischemic attack and acute stroke syndrome (22%); and constitutional conditions, such as fever, myalgia, arthralgia, fatigue, and myxoma infections (17%). Echocardiography proved to be a readily available and accurate diagnostic test. The majority of reported patients experienced full recoveries after surgical intervention.
CM is a rare but potentially life-threatening condition. Symptoms and signs relating to CM mimic other, more common conditions, resulting in diagnostic delay. Echocardiography can quickly and accurately diagnose CM and timely surgical intervention is curative. Clinician awareness of this condition, in a suggestive clinical context, will increase the likelihood of optimal patient outcome.
Atrial septal hematogenous cyst with calcification mimicking myxoma: A rare case
2023, Echocardiography
Unusual presentation of atrial myxoma: A case report and review of the literature
2021, American Journal of Case Reports
Central nervous system and limb embolism concurrence due to atrial myxoma: A case report
2017, Journal of Tehran University Heart Center

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VascularEmbolic atrial myxoma causing aortic and carotid occlusion

Abstract

Background

Case Description

Conclusions

Introduction

Section snippets

Case report

Discussion

Acknowledgments

Clin Neurol Neurosurg

J Am Soc Echocardiogr

An Pediatr (Barc)

Transient ischaemic attack: a common initial manifestation of cardiac myxomas

Eur Neurol

Fulminant brain necrosis from atrial myxoma showers

Stroke

Simultaneous occlusion of the abdominal aorta and both internal carotid arteries as the presenting symptoms of left atrial myxoma

Arch Mal Coeur Vaiss

Neurological manifestations of cardiac myxoma: a review of the literature and report of cases

Intern Med J

Vascular
Embolic atrial myxoma causing aortic and carotid occlusion