A 58-Year-Old Woman With a History of Cardiac Myxoma Presents With Pulmonary Nodules

Abstract

A 58-year-old woman presented to a pulmonology clinic for evaluation of bilateral pulmonary nodules. Two years previously, she had presented with atrioventricular nodal reentrant tachycardia. During evaluation for her tachyarrhythmia, transthoracic echocardiogram (TTE) revealed a large, homogenous, highly mobile right atrial and ventricular mass. She underwent electrophysiologic ablation, tricuspid valve annular ring replacement, and resection of the mass, which pathology confirmed to be a myxoma. Now, a recent abdomen and pelvis CT study obtained for history of nephrolithiasis incidentally noted bilateral lower lobe pulmonary nodules. Follow-up noncontrast chest CT confirmed bilateral peribronchovascular solid pulmonary nodules up to 8 mm in diameter throughout all lobes. The nodules appeared contiguous with the segmental and subsegmental bronchovascular bundles, and many occurred at branch points. There was no mediastinal or hilar lymphadenopathy. To evaluate the pulmonary nodules, she was referred to a pulmonology clinic. She reported only stable, nonlimiting dyspnea on exertion. She did not have a cough. She denied a history of fevers, weight loss, or night sweats. She had no rash or skin changes, visual changes, joint pain or swelling, or palpitations. She had no history of oropharyngeal or genital ulcerations. Social history was notable for a 40-pack-year smoking history, with quit date 2 years prior. She had no risk factors for TB exposure and no exposures to sandblasting, stone cutting, or other environmental risk factors for silicosis. Family history was negative for autoimmune conditions, sarcoidosis, and lymphoproliferative disorders.

72-year-old woman with dyspnoea and pulmonary artery filling defects on CT angiogram

“…It is well documented that chronic pulmonary obstruction caused by myxoma emboli can lead to irreversible pulmonary hypertension. There are a few literature reports of pulmonary artery aneurysms due to embolization from right-sided cardiac myxoma 6…”

Risk factors assessment and a Bayesian network model for predicting ischemic stroke in patients with cardiac myxoma

“…Although several risk factors of embolism (i.e., size of tumor and sex) (11, 12) in CM-IS patients have been reported, they are still controversial. Currently, the occurrence of CM-IS is believed to result from the interaction of multiple risk factors such as age (13)(14)(15), sex (12, [16][17][18], past medical history (19,20), and tumor characteristics (21)(22)(23).…”