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Left atrial (LA) myxoma presenting with symptoms of mitral stenosis in elderly males is very rare accounting for 10% of the cases. We report an 80-year-old male who presented with symptoms of ortho-pnea and palpitations and was subsequently found to have a large LA myxoma obstructing the mitral valve and causing pulmonary hyper-tension (PHT).
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Context 1
... atrial (LA) myxomas are the most common primary car- diac tumors and can have varied modes of presentation. Apart from embolic and systemic symptoms, they can mimic mitral stenosis when they obstruct the mitral valve. A high index of suspicion is required when they present in elderly males with symptoms of mitral valve obstruction. An 80-year-old male presented to us with symptoms of parox- ysmal nocturnal dyspnea (PND), orthopnea, and palpitations for 3 months duration. Symptoms had particularly worsened after the onset of palpitations. He had no prior risk factors like dia- betes, hypertension, ischemic heart disease, and hypo/hyperthy- roidism. He also denied any constitutional symptoms like fever, weight loss, and arthralgia. On examination his pulse was ir- regular (100 beats/min), and blood pressure was 112/70 mm Hg. Cardiovascular examination revealed a variable first heart sound, mid diastolic murmur at the apex, no tumor plop, and loud pul- monary component of second heart sound. ECG showed atrial fibrillation. Chest X-ray revealed a straight left heart border with features of pulmonary venous hypertension. 2D echocardiogram (Fig. 1-3) showed a large homogenous pedunculated mass (4.7 × 3.2 cm) attached to interatrial septum obstructing the mitral valve in diastole (Supplementary video 1, www.cardiologyres. org). There was moderate tricuspid regurgitation with a TR jet of 60 mm Hg indicating pulmonary hypertension (PHT). The patient underwent successful surgical excision of the mass (Fig. 4). Histopathology was consistent with myxoma. Myxoma is the most common primary cardiac tumor with an incidence of 0.0017-0.19% in autopsy series. They account for 80% of primary tumors [1]. Most common age of presenta- tion is between 3 and 80 years with a female preponderance. Sporadic cases present in the fifth decade while familial cases present in the second decade. Familial myxomas are usually multiple with a high recurrence rate. Seventy-five percent of myxomas are located in the left atrium, 20% in the right ...
Citations
... However, pulmonary hypertension, severe RV systolic dysfunction, and tricuspid regurgitation are less commonly recognized sequelae. [4][5][6][7] In a study at the All India Institute of Medical Sciences, a tertiary referral center for patients with cardiovascular disease throughout Northern India, 70 cases of cardiac myxomas were identified in the 93,500 echocardiograms performed over an 11-year period. 7 Only five of the 70 patients had moderately to severely elevated RV pressures with tricuspid regurgitation, and only three patients had associated pulmonary hypertension, as seen in our patient. ...
... While the incidence of patients with atrial myxomas who develop RV failure is not known, other cases exist in the literature, suggesting it may be an underrecognized consequence of left atrial myxomas. 4,5,7 The use of TTE is important in the diagnosis of atrial myxomas since this diagnosis is only suspected clinically in about 5% of myxoma patients. 6 Additionally, as in the case of our patient, TTE allows for observation of hemodynamic compromise and late-stage myocardial changes that ensue from obstructive left atrial tumors. ...
• Left atrial myxomas can cause pulmonary hypertension and right-sided heart failure. • TTE can be used to identify an atrial mass and quantify its hemodynamic effects. • Excision of atrial myxoma is indicated to prevent obstructive physiology.
... 8,9 Left sided atrial myxomas can result in obstruction of blood flow through the mitral valve, mimicking mitral stenosis or mitral regurgitation-as in our case. 10 A large left atrial myxoma mimicking mitral stenosis was also reported in a patient with multiple syncopal episodes and severe exertion presenting with acute pulmonary edema. 11 Interestingly, although atrial myxomas are associated with embolic phenomena and death, the patient had a period of 6 months without diagnosis, but did not develop any adverse sequelae related to the condition. ...
Benign cardiac tumors are rare; they can present with nonspecific symptoms and represent a diagnostic challenge to the clinician. We describe an interesting case of a 26‐year‐old female who presented with a 6‐month history of cough, breathlessness, palpitations, dizziness, and fever. Despite repeated clinical reviews in the community, diagnosis of cardiac tumor was not made until she developed decompensated cardiac failure with bilateral pleural effusions and pulmonary edema. Echocardiogram revealed an enormous left atrial mass that extended one‐third into left ventricle during systole. The patient underwent successful surgical resection with histological confirmation of a benign atrial myxoma.
... Myxomas can cause a pulmonary or systematic embolism, depending on the position of the tumor in the heart [2]. It can cause obstruction in the blood flow, mimicking mitral stenosis like in our case or mitral regurgitation as a result of complete blockage of the valve [3,4]. Non-specific symptoms like fever, weight loss, and fatigue have also been reported [2]. ...
... Histology showed myxoid matrix with stellate or elongated polygonal cells, scattered lymphocytes and red blood cells in keeping with myxoma (Fig. 4). in the differential diagnosis in patients with suspected mitral valve disease [1,3]. Echocardiography should be performed as early as possible to establish a prompt diagnosis and management [6]. ...
Myxoma is the most common primary cardiac tumor and is usually located in the left atrium. Clinical manifestation relies in large part on the size, location, and architecture of the tumor. There are many reports in the literature of cardiac myxomas causing syncope, embolism, even myocardial infarction. We present a rare case of a patient who underwent urgent surgical resection of a large left atrial myxoma mimicking mitral stenosis. The postoperative course of the patient was uncomplicated. One year after surgery, the patient is asymptomatic and disease-free.
Los tumores cardiacos secundarios son 20-40 veces más frecuentes que los primarios. En torno al 80 % de los tumores primarios son benignos, y más del 50% de estos son mixomas. Dentro de los mixomas, el 80% se origina a nivel de aurícula izquierda, y su forma de presentación es muy variada, pudiendo provocar obstrucción del tracto de entrada del ventrículo izquierdo, arritmias y fenómenos embólicos.
