Neurological Manifestations of Medical Disorders
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
The diagnosis of atrial myxoma is difficult and often delayed. About 30 per cent of atrial myxomas cause cerebral emboli – accounting for about 0.4 per cent of all strokes. Nevertheless, stroke is the most common neurological presentation of this disease. The majority of patients with atrial myxoma (up to 90 per cent) present with constitutional symptoms of fatigue, fever, myalgia, arthralgia and weight loss. Cardiac symptoms are often present and include breathlessness in association with congestive failure and syncope. Investigations show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), anaemia, thrombocytosis or thrombocytopenia. Chest x-ray may show left atrial or ventricular enlargement and occasionally intracardiac tumour calcification. Echocardiography is the investigation of choice, but transthoracic studies have a false-negative rate of about 20 per cent. For this reason, if the clinical suspicion is high, transoesophageal echocardiography must be performed.
Practice Paper 7: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Atrial myxoma, despite being relatively rare, is the most common tumour of the heart. It is a benign gelatinous neoplasm and is predominantly found attached to the septal wall of the left atrium by a pedicle. Symptoms include chest pain, dyspnoea, fever, lethargy and weight loss. Auscultation may reveal a loud first heart sound and a diastolic ‘plop’ due to prolapse of the tumour through the mitral valve. The presentation is similar to infective endocarditis and can cause diagnostic difficulties. Atrial myxomas can often embolize (with typical embolic consequences), but they do not metastasize. Echocardiography is the investigation of choice, and usually identifies a cystic polypoid mass. Treatment is by surgical excision. If removal is not complete, myxoma may recur.
Cardiac Tumours
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
Myxomas are benign, slow-growing tumours presenting usually later in life but earlier detection is now more frequent due to advanced cardiac imaging. However, they can kill because of rapid growth due to haemorrhage and infarction with blockage within a chamber and prolapsing into the mitral valve leading to sudden death. They can also kill by embolizing into the coronary and cerebral circulation.8 If not completely excised, they will recur at the same site and the incidence is reported at about 2%. Sometimes they recur at intracardiac sites distant from the original resection, but this is usually in the familial form of the disease where it is likely to be multiple primary tumours rather than recurrence of the original tumour. Where metastases have been reported, detailed histological review shows that many of these are examples of malignant tumours, i.e. liposarcomas or rhabdomyosarcoma with extensive areas of myxoid degeneration. Obviously the cerebral cases need careful histological examination to diagnose ‘benign’ myxoma features. There is no evidence to suggest that a benign atrial myxoma has the capacity to progress to a malignant myxosarcoma. Great care must be taken in examining a tumour mass labelled as myxoma by the surgeon, to avoid missing a malignant tumour. Multiple sections must be taken, and increased cellularity especially beneath the surface, any atypia, mitotic activity, point to a malignant diagnosis. Obviously, haemorrhage, infarction, necrosis or size will not be helpful. Sometimes rarely, myxomas can coexist with other tumours such as lymphoma.10 Embolectomy specimens should always be examined to exclude myxoma being embedded in the embolus.
Rhabdomyosarcoma from uterus to heart
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Sohaib Roomi, Mahnoor Fatima Sherazi, Waqas Ullah, Omair Ali Khan, Artem Minalyan, Muhammad Atiq, Nishant Thalambedu
Cardiology Department was consulted. Initially, a presumptive diagnosis of atrial myxoma was made. Computed Tomography (CT) scan of the abdomen & pelvis revealed a 3 cm mass in the uterus. Biopsy of the uterine mass revealed it to be a rhabdomyosarcoma resembling an undifferentiated pleomorphic sarcoma (Figure 2). Pleomorphic cells with abundant mitosis and areas of necrosis were seen. At this point, atrial mass was presumed to be a myxoma and the cause of palpitations. As per Cardiology recommendation, It was excised and the mitral valve was repaired. Histological analysis of the atrial mass was consistent with the diagnosis of rhabdomyosarcoma (Figure 3). Histology of both atrial and uterine mass revealed a cellular malignant neoplasm composed of round to elongated markedly atypical cells enlarged with hyperchromatic nuclei and some cells with eosinophilic cytoplasm. Desmin positivity was observed on immunohistochemistry testing of uterine as well as the atrial mass. These findings, along with the patient’s clinical history, were consistent with the diagnosis of the rhabdomyosarcoma. After the surgical excision of the cardiac mass, the patient was scheduled for chemo/radiation therapy for uterine pathology. The patient stayed in the hospital for five days. She was discharged home and regular follow up was advised in the clinic with Gynecologic-Oncology, Cardiac Surgery, and Primary care Physician.
The use of point-of-care ultrasound in new-onset dyspnea: an unexpected diagnosis
Published in Acta Clinica Belgica, 2022
Emine Özpak, Loran Defruyt, Laura Braeckeveldt, Jens Czapla, Els Vandecasteele
The patient was admitted to the cardiology department for monitoring and further diagnostic work-up. Since a metastatic etiology could not be excluded at the moment of diagnosis, a CT scan of the abdomen was performed and tumor markers (carcinoembryonic antigen) were determined, which showed stable findings. A coronary angiogram did not show significant coronary artery disease and the patient was referred for urgent resection of the intracardiac mass through a minimally invasive surgical approach. The mass, with a size of 80 × 40 mm, was attached at the inferior part of the right inferior pulmonary vein (Figure 3). Cytological examination confirmed the diagnosis of atrial myxoma.
Intravenous thrombolysis for pure pontine infarcts caused by cardiac myxoma: a case report and literature review
Published in International Journal of Neuroscience, 2020
Mingming Dong, Yusong Ge, Jinwei Li, Kailei Fu, Liyang Zhang, Weiyu Teng, Li Tian
At discharge (2 weeks later), only numbness in the right limbs remained. The NIHSS score reduced to 0, and the anti-platelet treatment was continued for secondary stroke prevention (aspirin 100 mg PO q.d.). At the 4-month follow-up, the patient underwent resection of the left atrial myxoma. Subsequent histopathology confirmed a diagnosis of myxoma (Figure 3(A and B)). Five months after discharge, the patient had recovered completely, and the NIHSS and modified Rankin scale (mRS) scores were both 0.
Related Knowledge Centers
- Benign Tumor
- Cardiac Asthma
- Lightheadedness
- Mesenchyme
- Platypnea
- Shortness of Breath
- Syncope
- Neoplasm
- Heart
- Fossa Ovalis
- Shortness of Breath