Left ventricular mass: Myxoma or thrombus?

Raut, Monish S; Maheshwari, Arun; Dubey, Sandeep; Joshi, Sandip

doi:10.4103/0971-9784.148329

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…In this case, the emergence of an infectious thrombus on the right atrial myxoma made its diagnosis difficult; however, some cases of thrombus mimicking myxoma are also reported 30,45–47 . It is important to differentiate these two cases due to the use of different treatment methods 48 .…”

Section: Discussionmentioning

confidence: 90%

Diagnosis of the right atrial myxoma after treatment of COVID‐19: A case report

Jelodar

Mirzaei

Chenari

et al. 2023

Clinical Case Reports

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Key Clinical Message Atrial myxoma is a rare disease but has a broad clinical presentation and complication that involves several systems‐ heart, lungs, brain, and systemic. An interdisciplinary approach is very important to optimize the outcome in patients with atrial myxomas. A thorough examination by primary care providers is crucial. Then radiologists or cardiologists can help with imaging modalities that can help diagnose and characterize the tumor. Prior to surgical resection by cardiothoracic surgeons, patients need to be evaluated by pulmonologists, cardiologists, and anesthesiologists for preoperative risk stratifications. In patients with neurological complications, pulmonary complications, or infectious endocarditis, input from neurologists, hematologists, infectious disease specialists is essential for patient care. In case antiplatelet/anticoagulation therapy or antibiotic treatment is warranted, pharmacists can provide valuable recommendations. Abstract Myxoma is the most common benign cardiac primary tumor, occurring in the right atrium in only 15%–20% of cases. This disease is asymptomatic initially depending upon size of the tumor, and symptoms develop as the tumor spreads. Atrial myxomas are associated with a triad of complications, including obstruction, emboli, and constitutional symptoms (such as fever and weight loss). This regard, embolization of the pulmonary circulation system is a complication of right myxoma. The patient was a 40‐year‐old male who presented to the emergency department complaining of fever and confusion. He had been previously hospitalized due to COVID‐19 and treated with Remdesivir and plasmapheresis. He had tachycardia, tachypnea, thrombocytopenia, and increased liver enzymes. Chest imaging showed nodular lesions with necrotic areas and cavitary lesions in both lungs and the right atrium infected clot was seen in echocardiography. He was treated with intravenous antibiotics and finally underwent heart surgery due to the diagnosis of pulmonary septic embolism. The patient was finally diagnosed with right atrial myxoma according to heart mass histopathology. It is worth noting that the patient's thrombosis had already developed on the right atrial myxoma, which delayed the diagnosis in this patient. This thrombus formation was due to the hypercoagulability state of COVID‐19 and following the insertion of a central venous catheter to perform plasmapheresis as a complication of treatment. Special attention should be paid to thromboprophylaxis and the early diagnosis of intravascular and intracardiac thrombosis in COVID‐19 patients. Furthermore, the use of imaging modalities is recommended to differentiate thrombus from myxoma.

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Section: Discussionmentioning

confidence: 90%

Diagnosis of the right atrial myxoma after treatment of COVID‐19: A case report

Jelodar

Mirzaei

Chenari

et al. 2023

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…The polypoidal type tends to result in embolism because of its friable consistency and intracavitary location. 6 Furthermore, the left ventricle has a higher risk of embolization since the high mobility and pressure in it. In the literature reviewed by Meller et al, 7 64% of the patients with LV myxoma presented with systemic embolization, most of which were cerebral.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Myxoma Leading to Stroke

Kong

Wang

et al. 2015

Medicine

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Primary cardiac tumors are rare, and most are myxomas. Only approximately 5% of cardiac myxomas originate from the ventricles.We report the case of a 23-year-old man presenting with right hemiplegia and muscle strength degeneration under a diagnosis of stroke. Transthoracic echocardiography revealed a 29 × 26 mm mass arising from the anterior interventricular septum. The tumor was surgically removed, and histology confirmed the diagnosis of left ventricular myxoma.We report its clinical features and treatment to add to the current knowledge.

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“…Anticoagulation with high dose intravenous heparin or low molecular weight heparin has variable resolution rates 13-59%. Recombinant tissue plasminogen activator can be used for lysis of a mobile, pedunculated LV thrombus [11]. On the other hand, a large mobile thrombus with or without a hemodynamic alteration, prior embolic events, and failed anticoagulation are an indication for surgical removal [10].…”

Section: Treatmentmentioning

confidence: 99%

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

Cho

Quach

Reed

et al. 2020

BMC Cardiovasc Disord

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Background: A cardiac myxoma in a young person may pose a diagnostic challenge as symptoms may be variable and the differential diagnosis is wide. The differential diagnosis can include rheumatic mitral valve disease, pulmonary hypertension, endocarditis, myocarditis and vasculitis. Case presentation: This case report involves a 49 years old female with a 2.8 cm × 3.4 cm myxoma in the left atrium causing mitral valve obstruction. She presented with fatigue, fever of unknown origin, transient ischemic attack and shortness of breath. Prompt surgery is often recommended due to the risk of embolic complications or complete obstruction. Due to her symptoms, patient underwent successful cardiothoracic surgery to excise the myxoma within 2 weeks of confirmation by cardiac echocardiography. Conclusion: This case also emphasizes the diagnostic challenge as symptoms may be variable, ranging from fatigue, fever and shortness of breath to transient ischemic attack and at worst, sudden cardiac death. In conclusion, if a cardiac mass is suspected, echocardiography should be performed early. Surgical resection is curative and recurrence rate is very rare in sporadic isolated myxomas, however, recurrence can be higher in genetic diseases associated with increased frequency of myxomas such as Carney complex. This subpopulation of patients may present further research opportunity to learn more about the perioperative management of patients with myxomas such as determining the optimal time to surgical intervention and decision to anticoagulate.

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Left ventricular mass: Myxoma or thrombus?

Abstract: Patient with embolic episode should always be evaluated for cardiac mass. Mass in left ventricular can be a myxoma or thrombus even in a normal functioning heart. In either case, mobile mass with embolic potential should be surgically resected.

Cited by 10 publications

References 24 publications

Diagnosis of the right atrial myxoma after treatment of COVID‐19: A case report

Diagnosis of the right atrial myxoma after treatment of COVID‐19: A case report

Left Ventricular Myxoma Leading to Stroke

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

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