Sporadic multicentric right atrial and right ventricular myxoma presenting as acute pulmonary thromboembolism

Abstract

Multicentric cardiac myxoma is a rare syndrome; usually it is familial. We report a rare case of sporadic right atrium (RA) and right ventricle (RV) myxoma in a 26-year-old female presenting to our hospital for the evaluation of sudden onset of dyspnea and left precordial pain attributed to the embolization of degenerating tumor fragments to the pulmonary artery (PA). The exact incidence of sporadic multicentric RA and RV myxoma presenting as acute pulmonary embolism is unknown as multicentric RA and RV myxoma are very rare. Myxomas presenting as pulmonary embolism is <10%. Majority of cardiac myxomas present as exertional dyspnea, chest pain, positional syncope, fever, weight loss and other constitutional symptoms. Any young patient presenting with acute onset dyspnea with multiple cardiac masses may have tumor embolization to the PA diagnosis with transthoracic echocardiography and high-resolution computed tomography of thorax, fast-tracks patient transfer for urgent cardiac surgery to prevent further embolization.

Pulmonary Embolism Following Incomplete Surgical Resection of a Right Ventricular Myxoma: A Case Report and Review of the Literature

“…The oldest case was published in 1971 [14], and the most recent one, apart from ours, in 2016 [4]. Singh el al.…”

“…reported two cases of cardiac masses in his article, however only one of them was confirmed as a myxoma and included in our review [10]. Eight of the 11 cases were reported in English language [4–8, 10, 12, 13]. Urina Triana et al reported their case in Spanish language.…”

“…Systemic embolism is much more common than PE, as most myxomas are predominantly located in the left atrium. Only few cases of RV myxomas associated with PE were reported [4–14]. …”

“…Although the presentation was not the same for all the cases, eight cases showed that pulmonary embolism could be the first presentation of RV myxomas [4–9, 11, 12]. This indicates the significance of performing echocardiography in cases of unexplained PE especially in young patients who do not have risk factors of PE.…”

“…Those located in the right ventricle are rare [3], and they are of a particular concern because of the risk of pulmonary tumor embolism. Right ventricular (RV) myxomas accompanied by pulmonary embolism (PE) are reported only in a limited number of studies in the medical literature [4–14]. Herein, we present a case of a young man who suffered from PE after incomplete surgical resection of an RV myxoma.…”