Pulmonary embolism as the initial manifestation of right atrial myxoma

Abstract

Rationale: Pulmonary embolisms (PEs) are caused by emboli, which mostly originate from deep venous thrombi that travel to and suddenly block the pulmonary arteries. The emboli are usually thrombi, and right atrial myxoma emboli are rare. Patient concerns: A 55-year-old man presented with shortness of breath and syncope. We proceeded with computed tomography pulmonary angiography (CTPA) and transthoracic echocardiogram (TTE), the results of which suggested that the diagnosis was a right atrial mass. Diagnosis: A definitive diagnosis compatible with a right atrial myxoma (RAM) with tumoral pulmonary emboli after surgical excision was made. Intervention: Right atrial and pulmonary artery embolectomy. Outcomes: The patient followed an uneventful course during the 6 years of follow-up after surgery. According to a review of the literature, RAMs are often not diagnosed in a timely manner or even go completely undiagnosed. TTE, transesophageal echocardiography (TEE), CT, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography may be helpful in the preoperative diagnosis. Surgical removal of the masses from the atrium and pulmonary arteries was relatively uneventful. Lessons: RAMs should be considered unlikely reasons for fatal pulmonary embolisms.

Characterizations of Ischemic Stroke Complications in Cardiac Myxoma Patients at a Single Institution in Eastern China

“…Embolic events may involve the central nervous system, the extremity, visceral, coronary, and pulmonary emboli. [8][9][10][11] Our results also showed the involvement of ischemic stroke, the extremity, coronary, and aorta emboli. Embolic events in atrial myxoma are thought to be secondary to embolization of tumor particles.…”

Intraoperative embolism of a right atrial myxoma: a case report

“…Right atrial myxomas may further present with right heart failure symptoms like pedal oedema, ascites and hepatomegaly due to functional tricuspid stenosis 7 or can cause pulmonary embolic events 4 as in our case. The first line imaging method of choice for diagnosis is echocardiography with sensitivity that can reach up to 100% if transoesophageal echo is used.…”

“… 2 Clinical presentation varies from constitutional symptoms to valvular manifestations and embolic events. 3 , 4 Echocardiography is the first line method for the diagnosis, 5 and surgical removal is the solely suggested treatment. In this case report, we present a patient with two right atrial myxomas, one of which embolized to the pulmonary artery (PA) trunk intra-operatively, causing acute respiratory failure and cardiogenic shock.…”

Right Atrioventricular Myxoma Presenting with Recurrent Syncopal Attacks

“…Patients with tumors on the right side of the heart may present with shortness of breath and easy fatigability, as in our case, due to pulmonary hypertension and right-sided heart failure. Embolization of right atrial myxomas may lead to pulmonary embolism [ 6 , 7 ]. Constitutional symptoms may include fever, loss of weight, anemia, and high ESR, mimicking infective bacterial endocarditis or systemic vasculitis [ 8 , 9 ].…”

“…Depending on their location, myxomas can mimic different diseases (ie, mitral stenosis, infective endocarditis, vasculitis, and pulmonary embolism) [ 6 – 9 ]. Here, we report a case of right atrioventricular myxoma presenting late that led to right ventricular (RV) outflow obstruction, pulmonary hyper-tension, and early manifestations of right-sided heart failure.…”