Severe functional mitral stenosis due to a left atrial myxoma masquerading as asthma

Abstract

While cardiac myxomas are the most common primary cardiac tumours, their overall incidence remains rare. Most cases (90%) are sporadic and occur in the third–sixth decades of life with a female predominance and have a specific predilection for the left atrium (75%). While often asymptomatic, clinical presentations depend on the tumour size, architecture and location. Echocardiography remains the mainstay for diagnostic evaluation. Tumour resection is the only definitive treatment. Histopathology using H&E and immunohistochemical stains, such as calretinin and CD34, confirms the diagnosis. We present a case of a patient with reported history of asthma who presented with recurrent acute on chronic shortness of breath refractory to inhaler therapy, multiple outpatient visits and hospitalisations for ‘asthma exacerbations’. After further evaluation, she was diagnosed with a left atrial myxoma attached to the inferior aspect of the intra-atrial septum complicated by severe functional mitral stenosis.

Series of patients operated for masses and cysts in the heart in a Spanish general hospital: A 20-year experience

“…Clinical manifestations are not very specific and may lead to misdiagnosis. Several cases have been described, in which the condition led to a first diagnosis of bronchial asthma 25 , as occurred in this series with two cases. The typical clinical presentation for cardiac masses described in the literature is intracardiac obstruction, thromboembolism, and constitutional symptoms 3,8,11,26 .…”

“…Las manifestaciones clínicas son poco específicas y pueden conducir a un diagnóstico erróneo. De hecho, ya se han descrito casos donde el cuadro orientó a un primer diagnóstico de asma bronquial 25 , como ocurrió en esta serie hasta en dos ocasiones. Así, en la literatura se habla con frecuencia de que la presentación clínica típica corresponde a la tríada de obstrucción intracardiaca, tromboembolismo y cuadro constitucional 3 , 8 , 11 , 26 .…”