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An echocardiographic-confirmed case of atrial myxoma causing cerebral embolic ischemic stroke: a case report.

Yoo M, Graybeal DF - Cases J (2008)

Bottom Line: A myxoma is the most common primary tumor of the heart.It has been reported as the source of a cardiogenic embolism.Therefore, it is important for clinicians to detect the myxoma early via echocardiography to prevent complications, such as syncope, sudden death, and cerebral embolic ischemic stroke.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. newmachine@dreamwiz.com.

ABSTRACT
A myxoma is the most common primary tumor of the heart. It has been reported as the source of a cardiogenic embolism. Therefore, it is important for clinicians to detect the myxoma early via echocardiography to prevent complications, such as syncope, sudden death, and cerebral embolic ischemic stroke. This report presents the case of a 54-year-old female whose clinical manifestation of atrial myxoma was an ischemic stroke. Atrial myxoma was later confirmed as the cause of her symptoms via transesophageal echocardiography.

No MeSH data available.


Related in: MedlinePlus

Transesophageal echocardiography shows a mobile mass in the left atrium, which does not obstruct the mitral valve. (A), After performing cardiopulmonary bypass, the retractor allows visualization of the left atrium, and the atrium is then opened by a blade. The myxoma is attached from the atrial septum. (B), LA myxoma: tan and jelly-like tissue with an aggregate measurement of 6 cm × 1.5 cm. (C).
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Figure 2: Transesophageal echocardiography shows a mobile mass in the left atrium, which does not obstruct the mitral valve. (A), After performing cardiopulmonary bypass, the retractor allows visualization of the left atrium, and the atrium is then opened by a blade. The myxoma is attached from the atrial septum. (B), LA myxoma: tan and jelly-like tissue with an aggregate measurement of 6 cm × 1.5 cm. (C).

Mentions: A 54-year-old Caucasian female presented to the emergency room with a 4 day history of left-sided weakness. The patient stated that she was at home when she suddenly felt a sharp pain in her left hand that radiated to her neck. She then lost consciousness and collapsed to the floor. It was not until 4 days later that her friend convinced her to go to the hospital. The patient had a medical history of longstanding hypertension, obstructive sleep apnea, hypothyroidism, and depression. She had been a smoker for 25 years. Her mother also had hypertension and her father had a myocardial infarction at the age of 56. Her height was 161.5 cm and her weight was 127.3 kg. The patient's vital signs were as follows: blood pressure, 153/104 mm Hg; heart rate, 101 beats/minute; respiratory rate, 18/minute; and body temperature, 36.6°C (98.0°F). She was alert and oriented, had left facial paralysis, slight dysarthria and right-sided tongue deviation, but no dysphasia. On cardiac examination, the carotid impulse was normal without a bruit. Her heart had a regular rate and rhythm, and there were normal S1 and S2 heart sounds without murmurs. An EKG showed a normal sinus rhythm. Range of motion was limited to 30° for the left upper and lower extremities. She had 1/5 motor strength on the left side, but 5/5 motor strength on the right side. The deep tendon reflexes were 2+ bilaterally. Her sensation was intact bilaterally. The Babinski and Hoffman signs were both negative. All her laboratory results were normal. A chest X-ray showed a normal cardiac silhouette with no signs of pulmonary edema. A non-contrast computed tomography (CT) scan of the brain revealed multiple low density areas in the right frontal and parietal lobes. Our stroke team started her on intravenous heparin. Metoprolol (Toprol-XL) and furosemide (Lasix) were administered to stabilize her blood pressure. The following day, magnetic resonance imaging (MRI) of the brain demonstrated an acute infarction in the distribution of the right middle cerebral artery (MCA; Figure 1). On the third day of hospitalization, the patient underwent a TEE. A TEE was chosen since the less invasive transthoracic echocardiography (TTE) showed negative imaging for a cardiogenic embolic source. In addition, the patient was obese and the TTE did not provide a comprehensive image. The TEE identified a 4.3 cm × 1.3 cm mass in the left atrium. A cardiac catheterization showed no significant coronary artery disease. The patient was thus diagnosed with a right MCA ischemic infarction and a left atrial myxoma. On the 13thhospital day, the patient underwent successful surgical excision of the myxoma (Figure 2). The biopsy confirmed the diagnosis of myxoma. The patient recovered without any complications and was discharged on the 20th day of hospitalization.


An echocardiographic-confirmed case of atrial myxoma causing cerebral embolic ischemic stroke: a case report.

Yoo M, Graybeal DF - Cases J (2008)

Transesophageal echocardiography shows a mobile mass in the left atrium, which does not obstruct the mitral valve. (A), After performing cardiopulmonary bypass, the retractor allows visualization of the left atrium, and the atrium is then opened by a blade. The myxoma is attached from the atrial septum. (B), LA myxoma: tan and jelly-like tissue with an aggregate measurement of 6 cm × 1.5 cm. (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2531170&req=5

Figure 2: Transesophageal echocardiography shows a mobile mass in the left atrium, which does not obstruct the mitral valve. (A), After performing cardiopulmonary bypass, the retractor allows visualization of the left atrium, and the atrium is then opened by a blade. The myxoma is attached from the atrial septum. (B), LA myxoma: tan and jelly-like tissue with an aggregate measurement of 6 cm × 1.5 cm. (C).
Mentions: A 54-year-old Caucasian female presented to the emergency room with a 4 day history of left-sided weakness. The patient stated that she was at home when she suddenly felt a sharp pain in her left hand that radiated to her neck. She then lost consciousness and collapsed to the floor. It was not until 4 days later that her friend convinced her to go to the hospital. The patient had a medical history of longstanding hypertension, obstructive sleep apnea, hypothyroidism, and depression. She had been a smoker for 25 years. Her mother also had hypertension and her father had a myocardial infarction at the age of 56. Her height was 161.5 cm and her weight was 127.3 kg. The patient's vital signs were as follows: blood pressure, 153/104 mm Hg; heart rate, 101 beats/minute; respiratory rate, 18/minute; and body temperature, 36.6°C (98.0°F). She was alert and oriented, had left facial paralysis, slight dysarthria and right-sided tongue deviation, but no dysphasia. On cardiac examination, the carotid impulse was normal without a bruit. Her heart had a regular rate and rhythm, and there were normal S1 and S2 heart sounds without murmurs. An EKG showed a normal sinus rhythm. Range of motion was limited to 30° for the left upper and lower extremities. She had 1/5 motor strength on the left side, but 5/5 motor strength on the right side. The deep tendon reflexes were 2+ bilaterally. Her sensation was intact bilaterally. The Babinski and Hoffman signs were both negative. All her laboratory results were normal. A chest X-ray showed a normal cardiac silhouette with no signs of pulmonary edema. A non-contrast computed tomography (CT) scan of the brain revealed multiple low density areas in the right frontal and parietal lobes. Our stroke team started her on intravenous heparin. Metoprolol (Toprol-XL) and furosemide (Lasix) were administered to stabilize her blood pressure. The following day, magnetic resonance imaging (MRI) of the brain demonstrated an acute infarction in the distribution of the right middle cerebral artery (MCA; Figure 1). On the third day of hospitalization, the patient underwent a TEE. A TEE was chosen since the less invasive transthoracic echocardiography (TTE) showed negative imaging for a cardiogenic embolic source. In addition, the patient was obese and the TTE did not provide a comprehensive image. The TEE identified a 4.3 cm × 1.3 cm mass in the left atrium. A cardiac catheterization showed no significant coronary artery disease. The patient was thus diagnosed with a right MCA ischemic infarction and a left atrial myxoma. On the 13thhospital day, the patient underwent successful surgical excision of the myxoma (Figure 2). The biopsy confirmed the diagnosis of myxoma. The patient recovered without any complications and was discharged on the 20th day of hospitalization.

Bottom Line: A myxoma is the most common primary tumor of the heart.It has been reported as the source of a cardiogenic embolism.Therefore, it is important for clinicians to detect the myxoma early via echocardiography to prevent complications, such as syncope, sudden death, and cerebral embolic ischemic stroke.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. newmachine@dreamwiz.com.

ABSTRACT
A myxoma is the most common primary tumor of the heart. It has been reported as the source of a cardiogenic embolism. Therefore, it is important for clinicians to detect the myxoma early via echocardiography to prevent complications, such as syncope, sudden death, and cerebral embolic ischemic stroke. This report presents the case of a 54-year-old female whose clinical manifestation of atrial myxoma was an ischemic stroke. Atrial myxoma was later confirmed as the cause of her symptoms via transesophageal echocardiography.

No MeSH data available.


Related in: MedlinePlus