Catastrophic Systemic Embolization from a Left Atrial Myxoma

Abstract

We report the fatal course of a left atrial myxoma: its systemic embolization to the coronary, cerebral, renal, and peripheral vascular beds in a 39-year-old W hen a patient presents with simultaneous vascular insults that involve multiple organ systems, a catastrophic clinical outcome can result. We report the case of a patient who had symptoms of systemic embolization, and we discuss the presentation, recognition, and treatment of the left atrial myxoma that was responsible. Case ReportA 39-year-old black woman was found unresponsive and in respiratory distress outside her home. According to her family, she had felt fatigued over the past 2 months and had occasionally reported fevers and night sweats. She had been taking oral contraceptive pills and smoked half a pack of cigarettes per day. Her personal and family medical histories yielded nothing else of note.Upon evaluation by emergency medical personnel, the patient was unconscious, tachypneic, and displaying possible seizure activity. In the emergency department, the patient was comatose with a Glasgow coma scale of 5, a temperature of 37 °C, a blood pressure of 117/77 mmHg, a heart rate of 133 beats/min, a respiratory rate of 30 breaths/min, and an oxygen saturation of 76% on room air. She was immediately intubated. A 12-lead electrocardiogram revealed 2-to 4-mm ST-segment elevation in the lateral leads, consistent with acute ST-elevation myocardial infarction (STEMI). Pertinent laboratory values included a cardiac troponin I level of 1.6 ng/mL, a white blood cell count of 13,800/µL, and an international normalized ratio of 1.21. The patient was anuric. A chest radiograph showed a normal cardiac silhouette with bilateral pulmonary edema. Aspirin (325 mg) was administered through a nasogastric tube, and an intravenous heparin drip was initiated. The diagnosis was cardiac arrest secondary to STEMI. A noncontrast computed tomographic scan of the patient's head was performed, and she was sent for emergent cardiac catheterization.Femoral arterial access was difficult to achieve in either groin because of the aspiration of thrombotic material. A 4F sheath was finally placed in the right femoral artery; the access sheath thrombosed twice during the procedure, necessitating the aspiration of large amounts of dark-red thrombus. Coronary angiograms obtained with use of 4F catheters showed abrupt thrombotic occlusion of the proximal-to-mid left anterior descending coronary artery, first diagonal branch, and proximal-to-mid left circumflex coronary artery (Fig. 1). The right coronary artery was angiographically normal. The occlusions were not suitable for catheter aspiration, balloon angioplasty, or stenting. A left ventriculogram showed a left ventricular ejection fraction (LVEF) of 0.30 and akinesis of the anterolateral, inferolateral, and apical walls. The computed tomographic report, received during the cardiac catheterization procedure, noted a large, acute embolic infarct in the region of the left middle cerebral artery. In view of the substantial thrombotic...

Intracranial and visceral arterial embolization of a cardiac myxoma that was treated with endovascular stent-retriever therapy

“…A variety of strategies were used in these reports, including IV tPa, with variable outcomes. [8][9][10][11][12] In our case, the option of mechanical thrombectomy seemed most appropriate from the perspective of the pathophysiology of this event, the available tools, experience and resources. As a result, a successful primary thrombectomy was performed, in our case without IV tPa.…”

Case report: left atrial Myxoma causing elevated C-reactive protein, fatigue and fever, with literature review

“…Definitive diagnosis would involve microscopic evaluation of the mass which typically shows thinwalled vasculature dispersed within a mucinous, myxoid background with perivascular eosinophilic cells, consistent with myxoma cells. Calretinin staining of the mass will also be strongly positive, confirming the presence of cardiac myxoma cells [7].…”