Cutaneous embolization of cardiac myxoma

Abstract

Atrial myxoma is the most common primary tumour of the heart. Skin manifestations in patients with a cardiac myxoma are frequent and may be due to cutaneous emboli, or may be specific findings as part of more complex syndromes. We present a 33-year-old-man with a history of episodes of pain in both legs and an ischaemic neurological event, who also had episodes of acral papular erythematous lesions on the legs and feet including the soles. The histological finding of dermal vessels occluded by a myxomatous material was the clue to the diagnosis of a cardiac myxoma. The diagnosis of this entity can be very difficult, because of the broad spectrum of clinical features; rarely the skin manifestations lead to the diagnosis of this tumour. The histological recognition of the myxomatous emboli is of vital importance for the diagnosis and treatment of this disease.

Cutaneous embolism of an atrial myxoma

“…The demonstration of a myxomatous embolus in a skin biopsy is not always possible, and it often requires the examination of multiple sections or multiple biopsies . A cutaneous embolism from an atrial myxoma has been reported on eight occasions previously, however, most of these cases also presented with neurological symptoms, which facilitated the diagnosis. In addition, cases presenting with isolated skin lesions were diagnosed only after a histopathological correlation of biopsy specimens …”

Nicolau syndrome as an avoidable complication

“…Skin manifestations in patients with a left atrial myxoma are frequent, usually on acral sites, and accompanied by cardiopulmonary symptoms. [7]…”

Anticipated diagnosis of left atrial myxoma following histological investigation of limb embolectomy specimens: A report of two cases

“…However, in cases of massive embolism, the cardiac tumor can disappear 7,15,16 . Occasionally, the existence of a cardiac myxoma has been anticipated following the histological examination of an embolus 6,7 or skin biopsy 17–22 …”