Massive right atrial myxoma presenting as congestive heart failure: an unusual presentation of a rare tumour

Agrawal, Richa; Sharma, Ajay; Nath, Ranjit Kumar; Pandit, Bhagya Narayan

doi:10.1136/bcr-2017-223903

Cited by 7 publications

(11 citation statements)

References 6 publications

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“…Right atrial myxomas may obstruct the tricuspid valve, the manifestation of which may be heart failure[ 50 , 51 ] or even collapse[ 52 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiac myxomas: A narrative review

Islam¹

2022

WJC

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Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.

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“…Right atrial myxomas may obstruct the tricuspid valve, the manifestation of which may be heart failure[ 50 , 51 ] or even collapse[ 52 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiac myxomas: A narrative review

Islam¹

2022

WJC

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“…On the other side, right atrial myxomas can cause tricuspid valve obstruction and are associated with right-sided heart failure symptoms such as dyspnoea, ascites and pedal oedema. They can also result in pulmonary emboli if a patent foramen oval coexists 8…”

Section: Discussionmentioning

confidence: 99%

Massive atrial myxoma presenting with unexplained haemoptysis

et al. 2022

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Cardiac myxomas are scarce and their clinical manifestations can often be misdiagnosed or confused with other medical conditions. However, early diagnosis and surgical resection can prevent devastating complications of myxomas.We herein describe a case of a huge left atrial myxoma of a female patient in her late 30s. What makes our case unique, apart from the massive size of the myxoma, is the unusual clinical presentation with incessant cough and haemoptysis for more than 6 months. The diagnosis was made by echocardiography and cardiac MR and successful surgical resection was performed with good long-term outcome.

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“…For patients with left-sided myxomas, obstruction may lead to pulmonary congestion or systemic circulation ischemia, in which case dyspnea [9] or syncope [10] may be the chief complaint. Whereas for patients with right-sided myxomas, peripheral edema, ascites, or superior vena cava syndrome which supposed to be caused by systemic congestion, are more common [4]. Embolic symptoms would be determined by the site of the embolization, which are essentially decided by the position of the myxomas.…”

Section: Discussionmentioning

confidence: 99%

“…Even though the symptom had appeared for only two months, the huge myxoma had already caused severe RVOT obstruction and right heart failure with systemic congestion. In such a case, RVOT obstruction rather than inherent pump failure should be responsible for the right-heart-failure-like symptoms [4]. Once the myxoma was surgically resected in time, those symptoms would disappear without severe consequences.…”

Section: Discussionmentioning

confidence: 99%

“…Only rare cases have been reported of myxomas originating from ventricular chambers (2.5-4%) [1][2][3]. Moreover, the clinical symptoms of cardiac myxomas vary greatly on a case-to-case basis [2][3][4][5], largely depending on their size, location and mobility. A peripheral embolic event in patients without any conventional risk factors may prompt a suspicion of a left-sided cardiac myxoma [6]; however, the manifestations of a right-sided cardiac myxoma are often uncharacteristic, leading to delayed diagnosis, treatment and unfavorable outcomes [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Giant right ventricular myxoma presenting as right heart failure with systemic congestion: a rare case report

Chen

Yang

2021

BMC Surg

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Background Myxoma is an uncommon disease and its symptoms vary greatly depending on size, location and mobility. Right-sided myxoma, especially right ventricular myxoma, is much rarer, and the symptoms are alien and uncharacteristic. The lack of understandings poses challenges to prompt diagnosis and timely treatment. Case presentation A 44-year-old female patient was diagnosed with giant right ventricular tumor. Right heart failure and systemic congestion caused by right ventricular outflow tract obstruction were observed on this case. Surgery was performed to excise the mass which was measured at 9.5 * 5.0 cm and confirmed as myxoma pathologically. Conclusions Right-side myxoma is easy to be unnoticed due to its low incident rate and atypical symptoms. Delay in surgical intervention might cause unrecoverable complications. More comprehensive understanding of the symptoms is expected to help improving the diagnose and treat of right-sided myxoma.

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Massive right atrial myxoma presenting as congestive heart failure: an unusual presentation of a rare tumour

Cited by 7 publications

References 6 publications

Cardiac myxomas: A narrative review

Cardiac myxomas: A narrative review

Massive atrial myxoma presenting with unexplained haemoptysis

Giant right ventricular myxoma presenting as right heart failure with systemic congestion: a rare case report

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