Content area
Full text
Left atrial myxomas are rare primary cardiac tumors. Their incidence is estimated to be about 0.1% of total cases. Neurological complications resulting from cardiac myxomas are seen in 20-35% of patients. Transesophageal echocardiogram (TEE) is preferred over transthoracic echocardiogram for evaluation of left atrial myxoma. Three-dimensional (3D) echocardiography ensures better visualization of intracardiac structures. It has been used prior to surgery for diagnostic support in the surgical treatment of cardiac masses. We present a case of a 46-year-old Hispanic male who developed acute ischemic stroke of left frontal lobe and was also found to have multiple 'silent' cerebral infarcts in the MRI of the brain. On further workup, he was found to have a left atrial myxoma on 3D TEE. This was resected with the assistance of intra-operative 3D TEE imaging. We present this case to increase awareness and to stress at early evaluation of secondary causes of ischemic cerebrovascular accident, outside the realm of hypercoagulability. This case also exhibits the need for basic cardiac workup in young individuals who present with symptoms of intermittent palpitations or chest pain to minimize significant morbidity or mortality.
Keywords: left atrial myxoma; three-dimensional transesophageal echocardiogram; acute stroke
Primary cardiac tumors are extremely rare. Their incidence is estimated to be about 0.1% of total cases on autopsy (1). Most tumors are found incidentally using imaging techniques such as MRI, two-dimensional (2D) echocardiogram, and/or CT imaging. Neurological complications resulting from cardiac myxomas are seen in 20-35% of patients due to embolization of the tumor which can cause thrombi in the systemic circulation (2, 3). Embolic strokes may occur any time with progression of the tumor. Most left atrial tumors also cause mitral regurgitation, leading to secondary pulmonary hypertension and heart failure (4). Surgical resection is the definitive treatment for a myxoma (5). We present a case of a 46-year-old Hispanic male who had a cerebrovascular accident (CVA) secondary to tumor embolization from a large left atrial myxoma found on three-dimensional (3D) echocardiography imaging.
Case description
A 46-year-old Hispanic male with no known past medical history arrived to the emergency department with his wife presented with slurred speech, confusion, blurry vision, and right upper/lower extremity weakness. Patient's symptoms began 1 day prior to presentation. At the time of presentation, his...