An Atypical Right Atrial Myxoma With Spontaneous Rupture

Abstract

SummaryTypically, cardiac maxomas arise from the interatrial septum at the border of the fossa ovalis in the left atrium, whereas atypical right atrial myxoma, especially with spontaneous rupture, is extremely rare. Here we report the diagnostic evaluation and successful surgical resection of an atypical myxoma with spontaneous rupture arising from the posterior wall of the right atrium in a 34-year-old male. (Int Heart J 2016; 57: 262-264) Key words: Cardiac tumor, Cardiac magnetic resonance P rimary cardiac tumors are very rare, with an autopsy incidence ranging from 0.001% to 0.030%. 1) Myxomas account for 50% of all benign tutors of the heart. They occur mainly in the third to sixth decade of life, affecting women more frequently than men. The majority of cardiac myxomas are located in the left atrium (75%), and rarely in the right atrium (RA, 10% to 20%).2) Most atrial myxomas have a stalk frequently attached to the interatrial septum at the border of the fossa ovalis and then in descending order of frequency from the posterior wall, anterior wall, and atrial appendage. 3)Echocardiograms and cardiac magnetic resonance (CMR) might be of important significance in the diagnosis and guiding treatment of cardiac tumors. Case ReportA previously healthy 34-year-old man was admitted to our hospital due to chest distress and polypnea which continued for 1 month. There was no history of coronary artery disease or trauma, and his family history was negative. On physical examination, a systolic grade II-VI blowing murmur was detected on the apex. His blood pressure was 120/60 mmHg and he had a regular pulse of 70 beats/min. The results of an examination of other systems were normal. The ECG revealed incomplete right bundle brunch block and V2~V6 lead ST-segment elevation. The laboratory findings were unremarkable.Transthoracic echocardiography (TTE) revealed the following: biatrium and right ventricular enlargement, moderate tricuspid valve regurgitation, a large echogenic mobile mass (5.3 cm × 4.2 cm) could be found in the RA, and a tortuous banded isoechoic structure attached to the mass protruding into the right ventricle during diastole ( Figure 1B) and entering into the RA during systole ( Figure 1A). However, left ventricular systolic function was normal with an ejection fraction of 61%.Cardiac magnetic resonance (CMR) was performed to further characterize the mass and confirmed a mass with spontaneous rupture arising from the posterior wall of the RA on a broad base (Figure 2 A, B, C). CMR could clearly show the location of the rupture (Figure 2, white arrow). The mass showed isointense signal intensity on T1-weighted imaging (T1WI, Figure 2D) and high signal intensity on T2-weighted imaging (T2WI, Figure 2E). Late gadolinium enhancement (LGE) images showed heterogeneous enhancement of the mass ( Figure 2F). The blood clot had higher signal intensity on T1WI and T2WI and nonenhancement on LGE (Figure 2, yellow arrow). The patient underwent resection of the right atrial mass with cardiopulmonary bypass, and i...

Calcified Amorphous Tumor-Induced Acute Cerebral Infarction

“…Abnormal calcium metabolism due to renal dysfunction and inflammation associated with hemodialysis may contribute to the genesis and further development of both MAC and CAT; most patients, including ours, with CAT originating from a heart chamber have renal dysfunction. 5) A definitive diagnosis of cardiac CAT is based on histologic examination that also rules out infective vegetation, myxoma, 9) and papillary fibroelastoma. It is difficult to differentiate a mobile cardiac tumor by means of diagnostic imaging, including transthoracic and transesophageal echocardiography, before surgical resection.…”

Differential diagnosis and morphological and functional characteristics of atrial myxoma

“…Среди вариабельной клинической симптоматики на первый план выходит симптоматическая триада: внутрисердечная обструкция (головокружение, одышка, кашель, отек легких и сердечная недостаточность), эмболия (из-за преобладающего левостороннего расположения, >50% эмболических событий затрагивают центральную нервную систему и артерии сетчатки) и конституциональные симптомы (потеря веса, лихорадка, миалгия, артралгия, синдром Рейно) в основном связаны с секрецией интерлейкина-6 опухолевыми клетками миксомы [10][11][12]. Описаны случаи инфицирования [5], случай внезапной сердечной смерти у пациента с МС [13], а также спонтанный разрыв сердечной стенки, ассоциированный с миксомой предсердия [14]. Со временем МС могут подвергаться петрификации.…”