Atrial myxoma producing a saddle embolus in a child

Massive embolization of cardiac myxoma. A case report

A case of left atrial myxoma with massive embolization in a 20-year-old woman is described. The initial clinical picture was confusing, but repeated examinations, including enzyme determinations and arteriographies, disclosed the presence of multiple arterial emboli. At embolectomy, histological investigation of embolic masses showed a picture indicating cardiac myxoma. This diagnosis was confirmed by pulmonary angiography and the tumour was removed. Postischaemic oedema of the legs necessitated decompression operations. The peripheral circulation was restored and the final result was excellent. Some aspects of the clinical presentation of this uncommon disease are discussed.

Total detachment of cardiac myxoma causing saddle embolization and mimicking aortic dissection

A 51-year-old male presented with sudden onset lower abdominal pain followed by weakness of both legs. Examination revealed blood pressure of 220/130 mmHg, with a grade 2/6 systolic murmur audible at the apex of the heart, and absence of both femoral arterial pulses. Two-dimensional and transesophageal echocardiography showed no evidence of intracardiac tumor or dissection of the ascending and thoracic aorta. Moreover, an aortogram demonstrated total occlusion of the abdominal aorta just below the renal arteries. A myxomatous-like material occupying the abdominal aorta just above the bifurcation of the common iliac arteries was discovered during surgery. Histologic examination of the embolic material confirmed the diagnosis of myxomatous embolus. One year after the embolic episode, the patient was well and two-dimensional and transesophageal echocardiography revealed no evidence of residual intracardiac tumor.

Surgery for cardiac myxomas

Myxomas, particularly left-atrial myxomas, are the most common primary tumors of the heart that cardiac surgeons will be called upon to remove. Although some tumors are discovered incidentally during echocardiographic examination, many produce symptoms caused by the release of inflammatory cytokines, obstruction to intracardiac blood flow, and/or embolization. With rare exception, cardiac myxomas are benign, and excision is safe and curative in most patients. In a 38-year experience at the Mayo Clinic, 100 patients have had 106 operations for myxoma, and there has been only 1 perioperative death. During follow-up extending to 25 years, postoperative survival is similar to that of an age- and sex-matched population, and at 20 years postoperatively, 94% of patients were free of recurrent myxomas. Recognition of familial and syndrome myxomas (eg, Carney's complex) is important in guiding surgical approach, planning follow-up, and predicting recurrence of these unusual neoplasms.

Massive embolism from cardiac myxoma

Two cases of massive embolism from atrial myxoma are described. One of these patients survived aortic surgery, and this is only the third recorded survival of this condition. Pre-operative angiography is essential to successful management of these cases, and direct aortic surgery is the only way to remove these firm tumor emboli.

Unusual presentation of bronchogenic carcinoma: case report and review of the literature

Although blood spread of pulmonary malignancy presumably occurs through microembolization, frank embolization of tumor fragments is uncommon. The first reported case of bronchogenic carcinoma appearing as a peripheral arterial embolus is described. The patient, a 64-year-old female, had acute ischemia of the left leg secondary to tumor embolism to the left profunda femoris and popliteal arteries. Shortly after embolectomy, she suffered atelectasis of the whole left lung from an epitheloid carcinoma in the left main bronchus. Twenty-eight cases of frank tumor embolism to the arterial tree occurring during the course of a noncardiac malignancy have been reported. None, however, occurred as an initial event. Pulmonary metastasis in patients with advanced malignancy was the source of the arterial emboli in 45% (13/29) of reported cases, but bronchogenic carcinoma was the original cell type in 38% (11/29) of cases. In general, arterial tumor embolism is a complication of advanced malignancy usually originating from one of multiple pulmonary metastases. This first case report of tumor embolism to a lower extremity occurring as the initial event in the clinical course of a bronchogenic carcinoma serves to emphasize the protein manifestations of malignant disease.