Left Ventricular Myxoma Causing Sudden Death

Unusual Presentation of Cardiac Myxoma Mimicking Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: A Report of a Rare Case

A cardiac myxoma is an authentic tumor that develops within the heart. Despite the typically benign histological characteristics, a cardiac myxoma may, on occasion, exhibit behavior reminiscent of malignant tumors. Most of these myxomas localize in the left atrium, often originating from a stalk near the foramen ovale region. The conventional presentation of cardiac myxomas includes a combination of obstruction, clot formation, and systemic symptoms, mirroring various other prevalent systemic diseases. They may manifest either spontaneously or through hereditary transmission. While familial myxomas are commonly linked to discernible genetic mutations, the precise molecular mechanisms underlying spontaneous myxomas remain somewhat enigmatic. Many individuals with myxomas may remain asymptomatic. However, should symptoms manifest, they can prove nonspecific and pose challenges in interpretation, particularly in instances of spontaneous heart myxomas. This report describes a 58-year-old female patient who presented with increasing severity of exertional dyspnea over a six-month duration. Initial differential diagnoses included common pulmonary and cardiac conditions, with a primary focus on chronic obstructive pulmonary disease and congestive heart failure. An echocardiogram revealed a large mass in the left atrium suggestive of a cardiac myxoma. Surgical resection confirmed the diagnosis. This case underscores the significance of including cardiac myxoma in differential diagnoses for progressive exertional dyspnea. Early detection and surgical intervention are crucial in mitigating potential complications like stroke, heart failure, or sudden cardiac death.

Multimodality Imaging of Benign Primary Cardiac Tumor

Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.

Left atrial myxoma with left ventricular myxoma diagnosed by ultrasound examination: A case report

RATIONALE

Left ventricular (LV) myxoma is a rare type of benign cardiac tumor, which may result in unfavorable consequences due to embolism, arrhythmia, obstruction to the outflow tract, and other constitutional symptoms. LV myxoma can be easily misdiagnosed as LV thrombosis. Although some literatures have reported LV myxoma, the echocardiographic features of Left atrial (LA) myxoma with LV myxoma have rarely been reported till date. Here, we report case of LA myxoma with LV myxoma diagnosed by echocardiographic examination.

PATIENT CONCERNS

A 56-year-old male patient suffering from chest tightness and asthma for 6 months and progressive aggravation for 1 month was admitted to our hospital.

DIAGNOSIS

Echocardiographic imaging gave the suspicion of LA myxoma with LV myxoma, which was confirmed by pathology.

INTERVENTIONS

This patient was treated surgically.

OUTCOMES

The patient had no postoperative complications and is currently under regular follow-up.

LESSONS

Echocardiography can be an effective imaging method for the evaluation of LV myxoma. The combination of echocardiography and clinical symptoms may help to make an accurate diagnosis.

Unexpected fatal intramyocardial cartilaginous tumor: pathophysiology, mechanism of death and review of the literature

Intramyocardial cartilage has never been reported in the human heart before. In the literature, the only reported localizations of cartilage in the heart were in the central fibrous body and the valves. We report a case of an unusual presence of cartilage tissue within the myocardial wall of the left ventricle in a 10-year-old boy who died unexpectedly. This case presents an interesting, unusual and apparently asymptomatic sudden cardiac death related to a cartilaginous myocardial tumor. Conducting system disturbance secondary to the myocardial tumor is the probable cause of death. This case is relevant not only for its singularity and originality, but also for the diverse and controversial hypotheses related to the onset of cartilaginous tissue in the myocardial wall. Early detection of this tumor by modern thoracic imaging may have prevented a fatal unexpected outcome.

Sudden death by massive systemic embolism from cardiac myxoma. Role of the clinical autopsy and review of literature

Cardiac myxoma is a rare benign neoplasm of the heart. Historically myxomas were incidental findings during autopsies, however improved imaging techniques made these diagnosis possible in living patients, making the surgical treatment of these neoplasms achievable. Cardiac myxomas may occur both sporadically and in a familial context, often in the clinico-pathological picture of the Carney complex. While familial myxomas occur in the context of well-known genetic mutations, the molecular etiology of sporadically occurring myxomas is still not completely clear. We must note however that many of the patients affected by myxomas are asymptomatic; when symptoms are present they are often nonspecific and hard to decipher, especially when referring to sporadically occurring heart myxomas. In this paper we describe a case of sudden death from the massive embolization of a left atrial cardiac myxoma. We also reviewed all the cases in the literature of sudden death from heart myxoma embolism. An accurate epidemiology of heart myxomas would be the key to outline the best treatment practices and the etiology of sporadic myxomas, nevertheless this target could only be pursued with a deep revaluation of the clinical autopsy as a fundamental diagnostic tool.

The First Manifestation of a Left Atrial Myxoma as a Consequence of Multiple Left Coronary Artery Embolisms

A case of multiple embolisms in the left coronary artery as a rare first manifestation of left atrial myxoma is reported. A patient with embolic myocardial infarction and congestive heart failure was treated by percutaneous aspirations and balloon dilatations. Transesophageal echocardiography disclosed a villous myxoma with high embolic potential. Surgical resection of the tumour, suturing of a patent foramen ovale suture and an annuloplasty of the dilated tricuspid annulus was performed the third day after the admission. Recovery of the documented left ventricular systolic function can be explained by resorption of myxomatous material. The patient was discharged ten days after the surgery.

Sudden cardiac death of Duchenne muscular dystrophy with NT-proBNP in pericardial fluid as a useful biomarker for diagnosis of the cause of death: a case report

Duchenne muscular dystrophy (DMD) is one of the most common and severest muscular dystrophies. Although it can be a cause of death when associated with cardiac muscle and/or respiratory muscles, no cases of sudden deaths in the setting of undiagnosed DMD with cardiac involvement have been reported in the literatures. Previous studies showed that N-terminal-proBNP (NT-proBNP) was a robust laboratory biomarker to diagnose and monitor cardiac failure in clinical situations, suggesting that it may be used as an auxiliary indicator for diagnosis on left ventricular dysfunction in sudden cardiac deaths in forensic settings. Here, we reported a case of 29-year-old man who died suddenly. Autopsy revealed that muscles of the body were almost replaced by fatty and fibrotic tissues. The heart was enlarged with disarray and degeneration of cardiomyocytes in cardiac muscle. Total absence of dystrophin was detected by immunohistochemical staining, which confirmed DMD. Postmortem biochemical test of pericardial fluid revealed a high level of NT-proBNP, indicating dysfunction of the left ventricle before death. The cause of death was certified as an early dilated cardiomyopathy (DCM)/dysfunction of the left ventricle secondary to DMD, suggesting that sudden cardiac death with cardiac dysfunction could be identified by immunohistochemical method in combination with pericardial fluid NT-proBNP determination after systemic autopsy.

Cardiac Tumors: Echocardiographic Diagnosis and Forensic Correlations

In the past, cardiac tumors were a just clinical curiosity and the prognosis was poor. Surgical management became possible after the advent of cardiopulmonary bypass, and more recently, preoperative diagnosis was greatly improved by the development of echocardiography, computed tomography, and magnetic resonance imaging. The value of echocardiography for diagnosing cardiac mass lesions has become well established. Numerous advances have occurred in the last 5 decades, and the evolution of echocardiography involves the development of its many modalities. This review is intended to help echocardiologists and forensic pathologists in providing good medical practice when faced with the challenge of investigating unexpected clinical signs, particularly in young people, or unexpected postmortem findings.

Left Ventricular Myxoma Leading to Stroke: A Rare Case Report

Primary cardiac tumors are rare, and most are myxomas. Only approximately 5% of cardiac myxomas originate from the ventricles.We report the case of a 23-year-old man presenting with right hemiplegia and muscle strength degeneration under a diagnosis of stroke. Transthoracic echocardiography revealed a 29 × 26 mm mass arising from the anterior interventricular septum. The tumor was surgically removed, and histology confirmed the diagnosis of left ventricular myxoma.We report its clinical features and treatment to add to the current knowledge.