Progressive wheeze: atrial myxoma masquerading as chronic obstructive pulmonary disease

Abstract

Atrial myxoma, the commonest primary cardiac neoplasm, presents with symptoms of heart failure, embolic phenomena or constitutional upset. We present an atypical case, with wheeze and symptomatic exacerbations typical of chronic obstructive pulmonary disease. With no early clinical evidence of heart failure, the patient was managed with inhaled steroids and bronchodilators, with little relief. Only when the patient was in extremis requiring intubation, due to respiratory failure, did clinical evidence of left heart failure become apparent, with echocardiography demonstrating a massive left atrial myxoma obstructing the mitral valve annulus. Following successful surgical resection, the patient's symptoms fully abated. This case highlights the importance of considering cardiac wheeze in those initially managed as obstructive airway disease not responding in a typical fashion to initial bronchodilator therapy, and particularly in those with rapidly progressive symptoms. Such patients should be referred early for cardiac imaging. The excellent prognosis and quick recovery after timely surgical resection of a myxoma are also highlighted.

Unusual Presentation of Atrial Myxoma: A Case Report and Review of the Literature

“…It is acknowledged that the unusual presenting features of atrial myxomas may lead to delayed diagnosis and poor outcome [ 8 ]. We found only 1 case report wherein a patient with a left atrial myxoma presented with recurrent wheeze, and another where the symptoms mimicked chronic obstructive pulmonary disease (COPD) [ 38 , 39 ]. Resection of the tumor resulted in complete resolution of respiratory symptoms [ 39 ].…”

“…Resection of the tumor resulted in complete resolution of respiratory symptoms [ 39 ]. The wheeze in patients with atrial myxomas has been attributed to increased production of interleukin-6, which is directly proportional to tumor size [ 38 ]. Wheezing may also result from pulmonary edema due to myxoma obstruction of the mitral valve with diastolic filling defect and increased pulmonary venous pressures (cardiac asthma).…”