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de Quadros Schroeder A, Greggianin C, Rover MM, Benedetto IG, Butzke M, Pinotti A, Wender O. A 30-Year-Old Woman With Arthralgia, Progressive Dyspnea, and a Syncope Episode. Chest 2024; 165:e173-e176. [PMID: 38852974 DOI: 10.1016/j.chest.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/20/2023] [Accepted: 01/15/2024] [Indexed: 06/11/2024] Open
Abstract
CASE PRESENTATION A 30-year-old White woman with presumed rheumatoid arthritis accompanied by CT scan evidence of eosinophilic pneumonitis was referred to the ED by her rheumatologist for an investigation of the progression of dyspnea. Approximately 6 months before, the patient reported experiencing diffuse interphalangeal arthralgias (both proximal and distal) that affected the wrists, knees, and feet. These symptoms were accompanied by Modified Medical Research Council scale grade 2 dyspnea. During the initial assessment, the patient exhibited slight pallor and had no indications of inflammatory activity in the joints. Furthermore, the cardiovascular physical examination and the auto-antibody laboratory profile yielded normal results. However, a wrist ultrasound scan revealed evidence of active synovitis; a chest CT scan displayed multifocal bilateral ground-glass opacities and mild thickening of the interlobular septa. These findings suggested the presence of eosinophilic disease or an acute interstitial process related to collagen vascular disease. Consequently, the patient's treatment commenced with a weekly dose of methotrexate (10 mg). Despite the intervention, 2 months later, the patient returned, reporting persistent arthralgia and a worsening of dyspnea, now classified as Modified Medical Research Council scale grade 3. Subsequently, the rheumatologist referred her to the ED for further assessment. During the initial emergency evaluation, the patient experienced a syncope episode accompanied by orthostatic prodromal symptoms that included dizziness, nausea, and malaise.
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Affiliation(s)
| | - Camila Greggianin
- Division of Thoracic Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Marciane Maria Rover
- Emergency Department, Hospital Moinhos de Vento and Instituto de Cardiologia, Porto Alegre, RS, Brazil
| | - Igor Gorski Benedetto
- Division of Respirology, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Mauricio Butzke
- Emergency Department, Instituto de Cardiologia and Hospital São Lucas, Porto Alegre, RS, Brazil
| | - Antonio Pinotti
- Department of Echocardiography, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Orlando Wender
- Division of Cardiovascular Surgery, Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Meng XH, Xie LS, Xie XP, Liu YC, Huang CP, Wang LJ, Zhang GH, Xu D, Cai XC, Fang X. Cardiac myxoma shedding leads to lower extremity arterial embolism: A case report. World J Clin Cases 2022; 10:10606-10613. [PMID: 36312464 PMCID: PMC9602238 DOI: 10.12998/wjcc.v10.i29.10606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/07/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023] Open
Abstract
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 embolization, 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.
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Affiliation(s)
- Xiao-Hu Meng
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Le-Si Xie
- Department of Pathology, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xu-Pin Xie
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Yong-Chang Liu
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Chang-Pin Huang
- Department of General Surgery, Hangzhou Geriatrics Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Lin-Jun Wang
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Guo-Hui Zhang
- Department of General Surgery, Hangzhou Geriatrics Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Dong Xu
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xu-Chao Cai
- Department of General Surgery, Hangzhou Geriatrics Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Xin Fang
- Department of Vascular Surgery, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Crea F. Challenges in risk stratification of symptomatic and asymptomatic valvular heart disease: lessons from large observational studies. Eur Heart J 2020; 41:4289-4292. [PMID: 33319244 DOI: 10.1093/eurheartj/ehaa951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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