Intracardiac Tumours

Abstract

Three cases of intracardiac tumour are reported in this paper and are of interest, apart from the comparative rarity of the condition, because in each case the clinical signs and symptoms suggested the presence of another lesion and the tumour was only discovered post-mortem.The first case, with a round-cell and spindle-cell sarcoma of the right auricle, showed in life the signs and symptoms of Ayerza's syndrome. The second, with a pedunculated myxomatous tumour of the left auricle, which projected through the mitral valve, was diagnosed as mitral stenosis. The third, with a tumour only in the sense that it was an intracardiac swelling, had a mycotic aneurysm arising at the attachment of the anterior cusp of the aortic valve, extending downwards into the interventricular septum and bulging into the right ventricle; the aortic valve was the seat of a bacterial endocarditis: in life the bulging into the right ventricle had obstructed the pulmonary valve, and a diagnosis of pulmonary stenosis and rheumatic carditis had been made.SARCOMA OF RIGHT AURICLE Case 1. A woman, aged 45 years, was admitted 30/7/41 complaining of increasing shortness of breath on exertion, of blueness of the lips for five months, and of a cough with scanty sputum for the past four weeks. Her doctor stated that auricular fibrillation had developed within the last week. She had always been strong and healthy except for a tendency to winter cough for the past five or six years. No history of rheumatic fever or chorea.On examination she was an obese woman with intense plum-coloured cyanosis but without dyspncea at rest. The heart appeared normal in size. Auricular fibrillation at 84 a minute was present. There were no murmurs. The blood pressure was 120/80. The lungs were emphysematous without any added sounds. The cervical veins were not overfilled, and there was no cedema of the subcutaneous tissues and no enlargement of the liver or spleen. The appearance of the patient suggested polycythemia, but her blood count showed 4-7 million red blood corpuscules and 94 per cent hemoglolin, with a colour index of 1b0. The urine was normal except for a trace of albumin. An electrocardiogram confirmed the presence of auricular fibrillation and showed low voltage of the QRS complexes and a flat T wave in lead III.There was no abnormal axis deviation.

Cardiac Myxoma

“…Chiari (quoted by Gorlitzer, 1934) described a case of myxoma of the right auricle, but in other reported cases the myxomas were either present in the left auricle (Yater, 1931 ;Gorlitzer, 1934;Jensen, 1934;Lymburner, 1934;Bien and Ch'in, 1936;Gilchrist and Millar, 1936;Bennett and others, 1938;Fawcett and Ward, 1939;Hamilton-Paterson and Castleden, 1942;Thompson, 1944;Burnett and Davidson, 1945) or on the heart valves (Abrahamer, 1931;Jaleski, 1934).…”

“…As the site of the tumour determines the clinical .picture in each case, a myxoma of the left auricle presents a picture of mitral stenosis with congestive cardiac failure (Jensen, 1934;Bien and Ch'in, 1936;Hamilton-Paterson and Castleden, 1942;Thompson, 1944;Burnett and Davidson, 1945) although the classical murmurs of mitral stenosis may be variable or absent (Lymburner, 1934;Bennett and others, 1938;Fawcett and Ward, 1939). The myxoma of the right auricle in this case presented the clinical picture of chronic superior vena caval obstruction with no evidence of organic cardiac disease, as shown by abnormal cardiac murmurs or arrhythmias.…”

Infected left atrial mass within anatomically normal heart.

“…In the early part of this century myxomas were thought to be thrombi undergoing myxomatous degeneration, but Yater (1931) and Prichard (1951) effectively established the current opinion that they are true neoplasms. The anatomical normality of the mitral valve in one case of pedunculated left atrial tumour described as a 'pseudo-myxoma' and believed to be thrombus (Hamilton-Paterson and Castleden, 1942) did not receive specific comment. Perhaps the absence of tumour cells in our patient was the result of such original cells having been effaced with the passage of time or shed from the original core of the tumour in an embolic disintegration.…”

Mass Thrombus of the Left Auricle

“…That a mass in the left auricle can cause murmurs which are indistinguishable by ordinary methods from those of mitral stenosis was the opinion of Ludwig (1933) who collected 20 reported cases and added another. It has also been stated that a tumour of the left auricle may cause severe symptoms without the production of murmurs (Shelburne, 1935;Bennett et al, 1938;Fawcett and Ward, 1939;Hamilton-Paterson and Castleden, 1942). Of the murmurs found in cases of tumour of the left auricle a systolic murmur was the usual one, although a presystolic murmur was sometimes present.…”