Anticoagulation therapy for pulmonary embolism involving a myxoma mimicking, giant type C thrombus: A case report

Right heart thrombus(RHTh) with concurrent acute pulmonary embolism(PE) is rare and can seriously destabilize hemodynamics, leading to an emergency situation with high mortality. Diagnosis and treatment of RHTh with acute PE are not yet standardized. There are few reports of acute PE concurrent with RHTh and even less is known about patients with a right heart mural thrombus. For physicians, the diagnostic choice and treatment of these patients are particularly difficult due to the lack of knowledge. Here, we report a rare case of partial mural RHTh(type C RHTh) with acute PE. The mural mass in the right heart was initially diagnosed as atrial myxoma according to transthoracic echocardiography(TTE), and both pulmonary embolus and the mural mass were completely absorbed after administering Rivaroxiban. This case suggests that TTE alone is insufficient to identify and diagnoses a right heart mural mass such as this. However, novel oral anticoagulants may be effective at alleviating PE with type C RHTh.

Acute Myocardial Infarction: Mode of Revelation of a Left Atrium Myxoma

True, cardiac myxoma is a benign tumor. On the other hand, it is serious by its complications, in particular embolic. The diagnosis of acute coronary syndrome in connection with a myxoma of the left atrium is retained before the association of an emboligenic intracardiac myxoma and an acute coronary syndrome in the absence of atherosclerotic lesions and the absence of intracardiac thrombus. We report a case of left atrium myxoma complicated by acute coronary syndrome in a 50-year-old patient operated on in our department and we will review the literature.

Dyspnea in a 26-Year-Old Woman with Fatal Left Atrial Myxoma

Cardiac myxoma is one of the primary intracardiac tumours. We report the case of a left atrial myxoma in a 26-year-old female patient admitted for investigation of dyspnoea. Echocardiography led to the diagnosis of a giant hypermobile myxoma prolapsing into the left ventricle. The patient died before being evacuated for surgical treatment.

Primary Cardiac Tumors Operated on in Côte d’Ivoire: They Are Almost All Myxomas

Objective: Through this surgical series, we present the epidemiological and anatomical-clinical aspects and the surgical results concerning patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Materials and Method: This is a retrospective descriptive study covering the period of January 1982 to December 2022, based on the medical records of patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Results: Twenty-seven (27) patients underwent surgery for a primary cardiac tumor, including 14 women and 13 men with a mean age of 41.5 years (range 19 - 76 years). The main circumstances of discovery were exertional dyspnea, palpitation and syncope or pseudo-syncope. The main site was the septal wall of the left atrium. The diagnosis of myxoma was confirmed by pathological examination of the surgical specimen in 96.3% (n = 24) of the patients and it was a malignant large cell immunoblastic lymphoma of the myocardium in 3.7% (n = 1) of the patients. The mean largest diameter was 46.1 mm. The postoperative course was marked by an ischaemic stroke (n = 1);recurrence of a left atrial myxoma 5 years after the first tumor removal (n = 1). Two cases of death were noted, one due to the evolution of immunoblastic large cell lymphoma and the other due to an extracorporeal circulation accident. Conclusion: Almost all primary cardiac tumors operated on in Abidjan are myxomas. The circumstances of the discovery of these cardiac tumors are multiple and varied but dominated by exertional dyspnea, palpitation and syncope. Whatever their histological type, primary cardiac tumors are serious affections, in view of the haemodynamic and rhythmic disorders they cause.

Extensive Odontogenic Myxoma of the Maxilla: A Case Report and Review of Literature

Odontogenic myxomas (OM), also called odontogenic fibromyxomas, are rare tumours of the jawbones. They are benign tumours that can be locally invasive and aggressive, but seldom undergo malignant transformation and do not give rise to metastases. They are often asymptomatic and present as painless swelling. We present herein the case of a 24-year-old patient, with an incidental finding of a maxillary lesion. The lesion expanded to the surrounding soft tissues of the face, the maxillary sinus, the nasal cavity and the ethmoidal cells. After confirmation of OM on biopsy, the patient underwent an extended right radical en bloc maxillectomy with immediate reconstruction of the inferior orbital rim. A literature review of clinical symptoms, radiological presentation, differential diagnosis and surgical management of OM is discussed.

Long-term outcome of patients with atrial myxoma after surgical intervention: analysis of 403 cases

Objective To assess long-term survival and late cardiovascular events in patients with atrial myxoma after surgical intervention. Methods Retrospective analysis of 403 patients undergoing resection of atrial myxoma from January 2002 to December 2016 was conducted with a median follow-up period of 4.5 (range: 0.5?15) years. Results The cross-clamp time and cardiopulmonary bypass times were 41.1 ± 21.4 and 65.2 ± 27.3 min,respectively. A diagnosis of myxoma was histopathologically confirmed in all cases. The early in-hospital mortality rate was 0.7%(n = 3). During the follow-up period,tumor recurrence occurred in six patients and cerebral infarction in nine. There were 48 (11.9%) patients with late onset atrial fibrillation (AF). By multivariate analysis,age (HR = 1.05,95% CI: 1.02–1.09,P < 0.001),left atrial diameter (HR = 1.23,95% CI: 1.08–1.36,P = 0.012),and mitral valve surgery (HR = 1.17,95% CI: 1.05–1.29,P = 0.027) were independent predictors of late onset AF. Twenty-one (5.2%) patients died during the follow-up period. Advanced age (HR = 1.07,95% CI: 1.04–1.10,P = 0.003) and multiple surgical procedures (HR = 1.18,95% CI: 1.06–1.29,P = 0.012) were significantly associated with overall mortality. Conclusions Atrial myxoma can be resected with good long-term survival. Late onset AF is common after surgery in patients with atrial myxoma. Advanced age,left atrial diameter,and mitral valve surgery were independent predictors of outcomes.

Left ventricular myxoma:Missed vs metastatic

Left ventricular myxomas account for 2.5% of all cardiac myxoma cases.There are very few case reports on left ventricular myxoma(LVM) presented after complete surgical resection of left atrial myxoma.Here we report a case of a 58-year-old male presented to the hospital for transient limb weakness,numbness and dysarthria.Magnetic resonance image of the brain revealed multiple thromboembolic cerebrovascular accidents.Transthoracic echocardiogram(TTE) revealed a left atrial myxoma.It was resected completely with good surgical margins.After one and half year he started having dizziness,and transient right sided weakness.Computer tomography scan of the head revealed a progression of thromboembolic disease.TTE revealed a LVM that was confirmed by transesophageal echocardiogram.It was resected with good surgical margins 3 wk after recurrent cerebrovascular accident.

Cardiac myxomas:A narrative review

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.

Thrombolysis and embolectomy in treatment of acute stroke as a bridge to open-heart resection of giant cardiac myxoma:A case report

BACKGROUND Cardiac embolism is a common cause of ischemic stroke in young adults.Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus.Early complete resection of giant cardiac myxoma is the key to its treatment and prevention of stroke recurrence.CASE SUMMARY A 42-year-old,previously healthy woman was admitted to the hospital with sudden-onset inability to speak and right-sided hemiplegia.While sweeping the floor 2 h prior to hospital admission,the patient developed sudden inability to express herself or understand what others were saying,accompanied by dyskinesia of the right limb,inability to walk or hold objects,and involuntary choreiform movements of the left upper limb.The patient was diagnosed with cerebral embolism and cardiac myxoma,complicated by left middle cerebral artery occlusion.The acute stroke was treated with intravenous thrombolytic therapy and arterial embolectomy as a bridging therapy to open resection of left atrial cardiac myxoma.The patient condition improved remarkably following initial thrombolysis and embolectomy and subsequently underwent emergency open resection of the atrial cardiac myxoma.She had no recurrence during 1-year follow-up.CONCLUSION Strong consideration should be given to urgent intravenous thrombolysis(rt-PA,alteplase)in young adult stroke patients at the time of hospital admission.The present case demonstrated a highly successful outcome that combined thrombolysis and arterial embolus retrieval as a bridge to early complete resection of a giant cardiac myxoma for both stroke treatment and recurrence prevention.

Multiple left ventricular myxomas combined with severe rheumatic valvular lesions: A case report

BACKGROUND Primary cardiac tumors are uncommon,of which cardiac myxoma accounts for 50%-80%.Left ventricular myxoma has been rarely reported,accounting for only 3%-4%of all cardiac myxomas.Multiple left ventricular myxomas are,relatively,even rarer.CASE SUMMARY In this report,we present a case of multiple left ventricular myxomas combined with severe rheumatic valve lesions.Symptomatically,the patient presented with fatigue,shortness of breath,and palpitation after activities.The patient underwent complete surgical resection of multiple left ventricular myxomas combined with mechanical replacement of the mitral and aortic valves,tricuspid valvuloplasty.The patient recovered well after the operation,with no obvious related complications.CONCLUSION Multiple left ventricular myxomas may coexist with severe rheumatic valve disease.Operation is an effective treatment.

Left ventricular myxoma:a case report

Cardiac myxoma,the most common primary heart tumor,is located mainly in the left atrium.We reported a rare case of left ventricular myxoma incidentally found on echocardiography in an asymptomatic 60-year-old male.The tumor was carefully resected without fragmentation.The patient had an uneventful recovery and was discharged home on the 4th postoperative day.Surgical resection of this type of cardiac myxoma is recommended due to the rarity of tumor location.

Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for more than ten years,in the buccal area of the anterior left mandible.According to the clinical features and the radiological diagnosis of odontogenic keratocyst,a conservative surgery with enucleation and curettage was performed.Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma.After 12-month of follow-up,no evidence of recurrence was found.Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.

Left Atrial Myxoma—A Case Report

Atrial myxomas are the most common primary cardiac tumors. More than 90% are solitary. A large myxoma occupying in the left atrium producing mitral stenosis and regurgitation was demonstrated by 2D echocardiographic images in this case. It remained asymptomatic for a long period with a survival up to the age of 75 years in an elderly female.

Familial cardiac myxoma with multifocal recurrences:a case report and review of the literature

We report a case of myxoma with multiple recurrences in both the atrium and ventricle in a 26-year-old woman five years after the surgical removal of left atrial myxoma, Her 52-year-old mother had a similar medical history. To our knowledge, this was the first familial case who suffered multifocal cardiac myxoma recurrences without any sign of the myxoma complex. Based on our understanding of the mechanism of recurrence, the approaches to prevent the recurrence, and markers to predict recurrence, we propose that multifocal recurrences, as reported herein, may result from a combination of familial predisposition and multifocal onset. The hi-atrial surgical approach and transesophageal echocardiography are preferred for patients with recurrent cardiac myxomas, especially for those with multiple recurrences and familial myxoma. Immunological and genetic screenings may help to identify family members at risk for developing this disease.

Right Ventricular Myxoma Causing Right Ventricular Outflow Tract Obstruction: A Case Report

A 63-year-old patient presented with dyspnea and chest distress. A computerized tomography and echocardiogram showed a cardiac mass in the right ventricle, which caused obstruction of the right ventricular outflow tract. Coronary angiography revealed a dense meshwork of the abnomorly capillary vessels originating from right coronary artery. The mass was completely excised under cardiopulmonary bypass. The mass attached right ventricle lateral wall and posterior triscupid leaflet. Histology was typical myomatous tissue.

Atrial Myxoma with a Dual Coronary Artery Supply

Primary cardiac tumours are rare, with myxoma being the most common benign heart tumour. The prevalence of coronary disease or neovascular in patients with atrial myxomas is high, yet angiography is not routinely performed. Echocardiography is preferred for evaluation of myxoma, where coronary angiography clarifies the vascular supply of the tumour and may alter the surgical planning. We here report an interesting and rare case of a left atrial myxoma hyper vascularised by two anomalous arteries, from right coronary artery and circumflex artery demonstrated by preoperative coronary angiography. The mass was successfully excised and the diagnosis of cardiac myxoma was confirmed via histopathology. A review of the value of coronary angiography in detecting myxoma neovascularization is provided. Offering additional valuable information, coronary angiography can alter the surgical approach and may therefore be considered prior to myxoma resection.

A Giant Right Atrial Myxoma with Blood Supply from the Left and Right Coronary Arteries:Once in a Blue Moon

Cardiac myxomas,the commonest primary benign cardiac tumors,are extremely rare,with an incidence ranging from 0.0017 to 0.19%and only about one-fi fth of them originating from the right chambers of the heart.A 60-year-old woman was admitted because of recurrent attacks of chest tightness and shortness of breath.Transthoracic echocardiography detected a giant mass in the right atrium;myxoma was indicated by[18 F]fl uorodeoxyglucose PET/CT.Preoperative selective coronary angiography was performed to assess the extent and severity of coronary stenosis,and showed a strongly neovascularized right atrial mass supplied by two feeding vessels with multiple branches from the left and right coronary arteries.The myxoma was successfully excised with open heart surgery and the patient was free of myxoma recurrence during the 3-year follow-up.

Laryngeal myxoma: A case report

BACKGROUND Myxomas are benign tumors of mesenchymal origin that rarely occur in the larynx.CASE SUMMARY We report a case of a laryngeal myxoma that presented as a right vocal cord mass in a 54-year-old man.CONCLUSION Laryngeal myxoma is a rare benign tumor in the larynx.It is difficult to distinguish glottis myxoma from vocal cord polyps on laryngoscopy.We recommend that otolaryngologists acquire a better understanding of this disease.If a laryngeal myxoma is suspected,dynamic laryngoscopy,acoustic voice analysis,and pathological biopsy should be performed.

Acute Respiratory Distress after Knee Arthroplasty Due to Undiagnosed Atrial Myxoma

Acute postoperative respiratory distress may be caused by pneumonia, pulmonary embolism, heart failure, pneumothorax or atelectasis. We present s case report of a 78-year-old female patient who developed acute respiratory distress one day following knee arthroscopy. Because of the suspicion of pulmonary embolism, a computed tomographic angiography was made, showing the presence of an unexpected large left atrial mass, suggestive for a myxoma. She underwent successful resection of a 10 × 5 cm myxoma one week later. The report discusses the clinical manifestations of an atrial myxoma and its potentially fast growth. Bedside echocardiography should be considered the preferred diagnostic modality in case of acute postoperative respiratory distress.

Cardiac myxoma shedding leads to lower extremity arterial embolism:A case report

BACKGROUND Left cardiac myxoma(CM)is the most common benign tumor of primary cardiac tumors,but because of its special position caused by pathological physiology change,caused by the complications of the heavier,the surface is often accompanied by blood clots,once fall out,it causes peripheral vascular embolization,such as acute lower limb artery embo-lization,harmfulness is large,high morbidity,and easy to occur repeatedly.CASE SUMMARY A 67-year-old male patient suddenly appeared numbness and weakness of the left lower limb and could not walk without obvious incentive.The patient was finally diagnosed as left CM complicated with acute lower limb arterial embolism after completing cardiac ultrasound,computer tomography angiography,and histopathological analysis,such as hematoxylin-eosin stain staining,immunohistochemistry and special staining including alcian blue staining and periodic acid schiff staining.Arterial thrombosis was removed successfully by femoral artery thrombectomy,postoperative numbness and weakness of the patient’s left lower limb disappeared,skin temperature became warm,and dorsal foot artery pulsation was accessible.The patient was readmitted to the hospital 8 mo after discharge for left atrial mass resection,and was diagnosed as CM by postoperative histopathological examination.CONCLUSION Although CM is rare,it may be considered as the source of embolism in patients with acute limb ischemia.Repeated loss of thrombus on the tumor and its surface may lead to repeated embolism of peripheral vessels.Cardiac ultrasound is helpful for early diagnosis.Here,we use this case report to highlight left CM as an important cause of acute limb ischemia and to report our experience in the diagnosis and treatment of lower limb arterial embolism caused by CM detachment.