Right atrial myxoma. A cause of septic pulmonary emboli in an adolescent female

Hemoptysis as an unusual manifestation of right atrial myxoma

Atrial myxoma is the most frequent tumor of the heart, though right-side locations and initial clinical manifestation in the form of hemoptysis are infrequent. We describe the case of a young woman with right atrial myxoma diagnosed by transthoracic echocardiography and presenting hemoptysis as the most important manifestation. The symptomatology disappeared after surgical removal of the lesion.

Clinical and radiographic spectrum of septic pulmonary embolism

AIMS

To review the clinical presentation, radiographic findings, and outcome of therapy in children with septic pulmonary embolism.

METHODS

Retrospective analysis of patients in a tertiary paediatric facility in northern Taiwan.

RESULTS

Ten children were identified with septic pulmonary emboli in a four year retrospective chart review between 1998 and 2001. Seven were immunocompetent, two were premature infants, one had beta thalassemia major. Seven had community acquired staphylococcal infections and bacteraemia, of which six were methicillin resistant Staphylococus aureus (MRSA) isolates. Five had soft tissue infections, two bone infections, one suppurative otitis media, one catheter related infection, and one unknown foci of infection. Multiple and bilateral nodular pulmonary parenchymal lesions were common on plain chest radiographs, but chest computed tomography scans showed the additional findings of a "vessel sign" and central cavitations, confirming the existence of septic pulmonary embolism.

CONCLUSIONS

Community acquired MRSA infections occurred in seven patients with septic pulmonary embolism but without predisposing high risk factors. Critically ill children with skin, soft tissue, or bone infections, when associated with septic pulmonary embolism in an area with a high rate of MRSA, should be empirically treated with glycopeptides (such as vancomycin or teicoplanin) before susceptibility results are known, in order to minimise morbidity and avoid mortality.

Infected cardiac myxoma. Case report and literature review

We present a case of a left atrial myxoma infected with Porphyromonas asaccharolytica in a 55-year-old man, successfully treated with surgical excision and a brief course of antibiotic therapy. Infected cardiac myxomas are extremely rare, with only 39 cases previously reported. They can be difficult to diagnose due to their protean clinical manifestations, which can often be seen in uninfected myxomas as well. We suggest that blood cultures and careful pathologic examination be performed in all cases of cardiac myxoma with constitutional symptoms. However, fever and elevated sedimentation rate are significantly more common in infected tumors. Organisms responsible are similar in distribution to those causing bacterial endocarditis. Emboli, though frequent, may not be more common in infected than uninfected myxomas. Case reports have become more common since the development of better diagnostic techniques. Echocardiography, especially by the transesophageal approach, is the diagnostic procedure of choice, and sensitivity approaches 100%. Surgical excision is curative and generally has low morbidity and mortality.

Myxomatous embolization resulting in unilateral amaurosis

A patient with sudden, painless monocular blindness is an uncommon emergency department presentation. Despite often futile attempts to treat the blindness, most clinicians search for a source of possible embolization. A patient is presented that developed monocular blindness without a clinically apparent source. Advanced diagnostic imaging showed a previously undetected atrial myxoma. The salient clinical features, diagnostic techniques, and therapeutic interventions for this uncommon cardiac tumor are discussed.