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Background
Tumours originating from the heart are a rarity with a reported incidence between 0.0017 and 2.8% in various autopsy series. 1 - 4 Most are true neoplasms, albeit benign, with myxomas accounting for more than half of these. 1 3 5 - 9 Myxomas are usually solitary and the most frequent site for a myxoma is the left atrium. 3 4 10 11 Systemic embolisation is a common complication with the brain harbouring majority of these metastases. 4 6 9 12 13 The intracranial manifestations observed include embolic infarcts, aneurysms, central nervous system (CNS) lesions and haemorrhage. Complete surgical resection is often curative in those with intracardiac disease alone. Although recurrence is rare, it is usually seen after embolisation of primary tumour, after an incomplete resection or in familial cases. 8 9 14 - 16
We report a case of a middle-aged female who developed non-aneurysmal, non-myxomatous intraparenchymal haemorrhagic sequelae following successful resection of her atrial myxoma.
We feel this is important to report for the following reasons: the patient did not have aneurysms and yet developed multi-focal CNS haemorrhage. Additionally, no malignant myxomatous features were reported on the histopathology of her CNS lesion after resection and yet she demonstrated repeated worsening of intracranial haemorrhage (ICH) in a naturally malignant course ( figure 1 ).
Case presentation
A 47-year-old previously healthy lady first presented to the emergency room in October 2010 with a new-onset chest pain along with dyspnoea and associated with off and on low-grade fever for the last 4 weeks. On examination, she was a middle-aged lady with average height and built, afebrile but with a mild tachypnoea. She was neurologically intact.
On initial presentation, the erythrocyte sedimentation rate was 38. Her arterial blood gases, urea and electrolytes, coagulation profile and liver function tests were unremarkable. Her chest x-ray did not reveal any abnormality. No neuroimaging was done at this stage as it was unwarranted.
A transthoracic echocardiogram (TTE) revealed a mobile, pedunculated, echogenic mass in the left atrium attached to the intra-atrial septum, 6x3x4 cm in size and causing mitral inflow obstruction. She then underwent surgical resection of the mass. She went home 5 days later in a stable condition. A postoperative TTE showed no residual mass. The final histopathology report...