Biatrial myxoma and multiple organ infarctions combined with Leriche syndrome in a female patient

Abstract

BackgroundMultiple organ infarctions combined with Leriche syndrome due to embolic particles of myxoma are very rare. There is no definite guideline for immediate medical treatment.Case presentationA 36-year-old married female was referred to the emergency department (ED) with severe pain of both lower extremities and gradual decreased mental status. Brain magnetic resonance imaging (MRI) and computed tomography angiography (CTA) revealed acute multiple organ infarctions including the brain, spleen, and bilateral kidneys combined with Leriche syndrome. To evaluate the embolic source, echocardiography was performed and it revealed biatrial myxoma. Because of the risk of progression in systemic embolic events, surgical excision and embolectomy were performed urgently. After the operation, renal function was recovered, and the pain of both limbs was relieved. However, the visual field defect due to the brain infarction remained. She was discharged uneventfully on the fourteenth postoperative day.ConclusionThis was an extremely rare case of multiple organ infarctions combined with Leriche syndrome as the initial presentation of biatrial myxoma. The treatment of choice for myxoma is surgical excision, but the optimal timing of operations is still controversial in patients who have had recent neurological insults. Echocardiography was useful to clarify the diagnosis and decide on the proper treatment modality: surgical treatment or thrombolysis.

Dumbbell in the atrium: A rare case report of biatrial myxoma that crosses atrial septum diagnosed by multimodal echocardiography

“…The incidence of primary cardiac tumors is .002%–.3%, 1 and cardiac myxoma consists 50%–80% of benign tumor. Primary sites are occupied by 75% in left atrium(LA), 2 15%–20% right atrium (RA), only 2.5% in both atria 3 .…”

Genuine biatrial myxoma: The rarest form of myxoma

“…Their incidence is 0.5 per million people per year [1]. About 75% of myxomas occur in the left atrium, 15-20% in the right atrium, 3%-4% in the left or right ventricle, and <2.5% in both atria [2]. Myxomas involving both atria are usually independent of each other [3].…”

Leriche Syndrome as a Long-Term Continuum of Vascular Injury: from the Initial Clinical Manifestations to Possible Fatal Outcome (Significance of Interdisciplinary Cooperation Based on Own Clinical Observations)

“…Маніфестні симптоми синдрому Леріша включають переміжну кульгавість, яка є інтермітуючою та білатеральною з ішемічним болем і відсутнім або зниженим феморальним (стегновим) та дистальним пульсом. Прояви можуть бути пов'язані з блідістю, похолоданням і втомленістю в нижніх кінцівках та ЕД, на яку чоловіки (особливо молодшого віку) можуть не відразу скаржитися лікарям первинної ланки [5,15,25,27,35]. При цьому ЕД, особливо у молодих чоловіків, може бути першим симптомом синдрому Леріша.…”