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      Left atrial myxoma complicated with multi-system embolization

      case-report

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          Abstract

          Background

          Atrial myxoma accounts for approximately 50% of all cardiac tumors. The majority of myxomas are located in the left atrium and present variable clinical manifestation.

          Case presentation

          A young man was transferred to our hospital with sudden onset of resting pain, pallor and numb in right leg. An atrial mobile mass was detected by transthoracic echocardiography. Anticoagulant and antithrombotic therapy were administered, a timely surgery was performed and the mass was confirmed as a myxoma. The patient did not discharge any discomfort post-operation.

          Conclusion

          For patients with atrial myxoma, early diagnosis is essential, anticoagulant or antithrombotic therapy and surgery have a great importance to prevent further embolism.

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          Most cited references16

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          Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study.

          John P. Rooney, J M Haering, James C. Waksmonski … (1995)
          To determine the ability of transesophageal echocardiography to accurately identify or exclude left atrial thrombi. Prospective cohort study. University hospital. 231 consecutive patients having transesophageal echocardiography before elective repair or replacement of the mitral valve or excision of a left atrial tumor. Fifty-six percent of patients had a history of atrial fibrillation, and 17% had a history of thromboembolism. Identification of left atrial thrombi during transesophageal echocardiographic examination and comparison with direct near-simultaneous visualization during cardiac surgery. Transesophageal echocardiography identified 14 left atrial thrombi in 14 patients (6%). Thrombus size range from 3 to 80 mm. Surgery confirmed 12 of 14 thrombi (86%), including 9 thrombi confined to the left appendage. No additional thrombi were found on direct inspection of the atria (sensitivity, 100% [95% CI, 74% to 100%]; specificity, 99% [CI, 97% to 99.9%]; positive predictive value, 86% [12/14]; negative predictive value, 100% [217/217]; for a population that had a 5.2% prevalence of thrombi). All 12 surgically confirmed thrombi were identified by two independent observers. Neither thrombus seen by only a single observer on transesophageal echocardiography was confirmed during direct inspection of the atria at surgery. Transesophageal echocardiography is highly accurate for identifying left atrial thrombi and can be used clinically to exclude left atrial thrombi.
          Article 0 comments Cited 81 times – based on 0 reviews     Review now
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            Cardiac Masses on Cardiac CT: A Review

            David Kassop, Michael S. Donovan, Michael Cheezum … (2014)
            Cardiac masses are rare entities that can be broadly categorized as either neoplastic or non-neoplastic. Neoplastic masses include benign and malignant tumors. In the heart, metastatic tumors are more common than primary malignant tumors. Whether incidentally found or diagnosed as a result of patients’ symptoms, cardiac masses can be identified and further characterized by a range of cardiovascular imaging options. While echocardiography remains the first-line imaging modality, cardiac computed tomography (cardiac CT) has become an increasingly utilized modality for the assessment of cardiac masses, especially when other imaging modalities are non-diagnostic or contraindicated. With high isotropic spatial and temporal resolution, fast acquisition times, and multiplanar image reconstruction capabilities, cardiac CT offers an alternative to cardiovascular magnetic resonance imaging in many patients. Additionally, cardiac masses may be incidentally discovered during cardiac CT for other reasons, requiring imagers to understand the unique features of a diverse range of cardiac masses. Herein, we define the characteristic imaging features of commonly encountered and selected cardiac masses and define the role of cardiac CT among noninvasive imaging options.
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              Pre-operative computed tomography coronary angiography to detect significant coronary artery disease in patients referred for cardiac valve surgery.

              Jolanda Kluin, Ad J. J. C. Bogers, Francesca Pugliese … (2006)
              We studied the diagnostic performance of 64-slice computed tomography coronary angiography (CTCA) to rule out or detect significant coronary stenosis in patients referred for valve surgery. Invasive conventional coronary angiography (CCA) is recommended in most patients scheduled for valve surgery. During a 6-month period, 145 patients were prospectively identified from a consecutive patient population scheduled for valve surgery. Thirty-five patients were excluded because of CTCA criteria: irregular heart rhythm (n = 26), impaired renal function (n = 5), and known contrast allergy (n = 4). General exclusion criteria were: hospitalization in community hospital (n = 4), no need for CCA (n = 4), previous coronary artery bypass surgery (n = 1), or percutaneous coronary intervention (n = 4). Of the remaining 97 patients, 27 denied written informed consent. Thus, the study population comprised 70 patients (49 male, 21 female; mean age 63 +/- 11 years). Prevalence of significant coronary artery disease, defined as having at least 1 > or =50% stenosis per patient, was 25.7%. Beta-blockers were administered in 71%, and 64% received lorazepam. The mean heart rate dropped from 72.5 +/- 12.4 to 59.5 +/- 7.5 beats/min. The mean scan time was 12.8 +/- 1.3 s. On a per-patient analysis, the sensitivity, specificity, and positive and negative predictive values were: 100% (18 of 18; 95% confidence interval [CI] 78 to 100), 92% (48 of 52; 95% CI 81 to 98), 82% (18 of 22; 95% CI 59 to 94), and 100% (48 of 48; 95% CI 91 to 100), respectively. The diagnostic accuracy of 64-slice CTCA for ruling out the presence of significant coronary stenoses in patients undergoing valve surgery is excellent and allows CTCA implementation as a gatekeeper for invasive CCA in these patients.
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                Author and article information

                Contributors
                Ren-Dan Zhang: zrdlcx1028@163.com
                Zhi-Huan Zeng: gzzh@163.com
                Jian-Yi Zheng: czhengjammy@163.com
                Tu-Di Li: 1650560149@qq.com
                Yan-Qun Zhao: gzzhyq@163.com
                Yu-Hong Liu: baii654@qq.com
                Yu-Si Yao: 1806506065@qq.com
                Journal
                Journal ID (nlm-ta): J Cardiothorac Surg
                Journal ID (iso-abbrev): J Cardiothorac Surg
                Title: Journal of Cardiothoracic Surgery
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1749-8090
                Publication date (Electronic): 5 September 2017
                Publication date PMC-release: 5 September 2017
                Publication date Collection: 2017
                Volume: 12
                Electronic Location Identifier: 76
                Affiliations
                ISNI 0000 0004 1758 4014, GRID grid.477976.c, Cardiovascular Department of First Affiliated Hospital of Guangdong Pharmaceutical University, ; Guangzhou, Guangdong 510080 People’s Republic of China
                Article
                Publisher ID: 640
                DOI: 10.1186/s13019-017-0640-2
                PMC ID: 5584343
                PubMed ID: 28870204
                SO-VID: 337593b1-86b0-4567-8a5b-8b391ab1c9ae
                Copyright © © The Author(s). 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 22 April 2017
                Date accepted : 27 August 2017
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Surgery
                Keywords: atrial myxoma,systemic embolism,therapy
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: atrial myxoma, systemic embolism, therapy

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