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Gholinataj Jelodar M, Mirzaei S, Dehghan Chenari H, Tabkhi M. Diagnosis of the right atrial myxoma after treatment of COVID-19: A case report. Clin Case Rep 2023; 11:e7216. [PMID: 37143454 PMCID: PMC10152069 DOI: 10.1002/ccr3.7216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
Key Clinical Message Atrial myxoma is a rare disease but has a broad clinical presentation and complication that involves several systems- heart, lungs, brain, and systemic. An interdisciplinary approach is very important to optimize the outcome in patients with atrial myxomas. A thorough examination by primary care providers is crucial. Then radiologists or cardiologists can help with imaging modalities that can help diagnose and characterize the tumor. Prior to surgical resection by cardiothoracic surgeons, patients need to be evaluated by pulmonologists, cardiologists, and anesthesiologists for preoperative risk stratifications. In patients with neurological complications, pulmonary complications, or infectious endocarditis, input from neurologists, hematologists, infectious disease specialists is essential for patient care. In case antiplatelet/anticoagulation therapy or antibiotic treatment is warranted, pharmacists can provide valuable recommendations. Abstract Myxoma is the most common benign cardiac primary tumor, occurring in the right atrium in only 15%-20% of cases. This disease is asymptomatic initially depending upon size of the tumor, and symptoms develop as the tumor spreads. Atrial myxomas are associated with a triad of complications, including obstruction, emboli, and constitutional symptoms (such as fever and weight loss). This regard, embolization of the pulmonary circulation system is a complication of right myxoma. The patient was a 40-year-old male who presented to the emergency department complaining of fever and confusion. He had been previously hospitalized due to COVID-19 and treated with Remdesivir and plasmapheresis. He had tachycardia, tachypnea, thrombocytopenia, and increased liver enzymes. Chest imaging showed nodular lesions with necrotic areas and cavitary lesions in both lungs and the right atrium infected clot was seen in echocardiography. He was treated with intravenous antibiotics and finally underwent heart surgery due to the diagnosis of pulmonary septic embolism. The patient was finally diagnosed with right atrial myxoma according to heart mass histopathology. It is worth noting that the patient's thrombosis had already developed on the right atrial myxoma, which delayed the diagnosis in this patient. This thrombus formation was due to the hypercoagulability state of COVID-19 and following the insertion of a central venous catheter to perform plasmapheresis as a complication of treatment. Special attention should be paid to thromboprophylaxis and the early diagnosis of intravascular and intracardiac thrombosis in COVID-19 patients. Furthermore, the use of imaging modalities is recommended to differentiate thrombus from myxoma.
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Affiliation(s)
| | - Samaneh Mirzaei
- Department of Health in Emergencies and Disasters, School of Public HealthShahid Sadoughi University of Medical SciencesYazdIran
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Channabasappa SK, Gupta B. Emergency decompressive craniotomy with scalp block and closed-loop TCI sedation for acute ischemic stroke in a patient with incidental diagnosed large left ventricular mass, presenting with severe LV dysfunction. J Anaesthesiol Clin Pharmacol 2023; 39:149-150. [PMID: 37250245 PMCID: PMC10220206 DOI: 10.4103/joacp.joacp_40_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/22/2021] [Indexed: 03/21/2023] Open
Affiliation(s)
| | - Bhavna Gupta
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Redzek A, Preveden A, Kaloci SR, Samardzija G, Preveden M, Golubovic M, Velicki L. Unusual non-valvular left ventricular endocarditis presenting as multiple brain embolism. Acta Clin Belg 2022; 77:142-146. [PMID: 32602786 DOI: 10.1080/17843286.2020.1789273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Masses inside the heart can cause serious and life-threatening effects to the cardiovascular system, mainly because of hemodynamic obstruction of the blood flow, either in the heart cavities themselves or remotely due to embolization. In this paper, we report a case of left ventricular tumor mass which presented with neurological symptoms due to multiple brain embolism. CASE REPORT A 35-year-old female patient presented with right hemiparesis and dysarthria. Seven days prior to admission she had elevated body temperature and started taking antibiotics. Inflammatory markers were not elevated, and blood cultures were negative. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed multiple acute ischemic lesions. Echocardiography showed the presence of a lobular mass inside the left ventricle, which was attached to the basal segment of the lateral left ventricular wall. Based on the laboratory results and additional heart imaging (CT and MRI) the mass was primarily suspected to be a tumor. It was surgically removed. Microscopic analysis of the removed tissue revealed a non-specific endocardial inflammation with formed fresh fibrin thrombi on the surface. During the postoperative recovery intense physical rehabilitation was being performed, so the initial neurological deficit was completely withdrawn. CONCLUSION Intracardiac masses can cause serious and potentially fatal complications that often present with dramatic clinical symptoms. Despite the comprehensive clinical, laboratory, and imaging investigations, intracardiac masses can be hard to distinguish until the definite microscopic analysis. However, with the right approach and multidisciplinary collaboration, they can be successfully managed.
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Affiliation(s)
- Aleksandar Redzek
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Andrej Preveden
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Svetlana Ruzicka Kaloci
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Golub Samardzija
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Mihaela Preveden
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Miodrag Golubovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
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Cho J, Quach S, Reed J, Osian O. Case report: left atrial Myxoma causing elevated C-reactive protein, fatigue and fever, with literature review. BMC Cardiovasc Disord 2020; 20:119. [PMID: 32138674 PMCID: PMC7059297 DOI: 10.1186/s12872-020-01397-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background A cardiac myxoma in a young person may pose a diagnostic challenge as symptoms may be variable and the differential diagnosis is wide. The differential diagnosis can include rheumatic mitral valve disease, pulmonary hypertension, endocarditis, myocarditis and vasculitis. Case presentation This case report involves a 49 years old female with a 2.8 cm × 3.4 cm myxoma in the left atrium causing mitral valve obstruction. She presented with fatigue, fever of unknown origin, transient ischemic attack and shortness of breath. Prompt surgery is often recommended due to the risk of embolic complications or complete obstruction. Due to her symptoms, patient underwent successful cardiothoracic surgery to excise the myxoma within 2 weeks of confirmation by cardiac echocardiography. Conclusion This case also emphasizes the diagnostic challenge as symptoms may be variable, ranging from fatigue, fever and shortness of breath to transient ischemic attack and at worst, sudden cardiac death. In conclusion, if a cardiac mass is suspected, echocardiography should be performed early. Surgical resection is curative and recurrence rate is very rare in sporadic isolated myxomas, however, recurrence can be higher in genetic diseases associated with increased frequency of myxomas such as Carney complex. This subpopulation of patients may present further research opportunity to learn more about the perioperative management of patients with myxomas such as determining the optimal time to surgical intervention and decision to anticoagulate.
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Affiliation(s)
- Jake Cho
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, 32827, USA. .,HCA Ocala Regional Medical Center, Internal Medicine Residency Program, 1431 SW 1st Ave, Ocala, FL, 34471, USA.
| | - Steven Quach
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, 32827, USA.,HCA Ocala Regional Medical Center, Internal Medicine Residency Program, 1431 SW 1st Ave, Ocala, FL, 34471, USA
| | - Justin Reed
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, 32827, USA.,HCA Ocala Regional Medical Center, Internal Medicine Faculty, Ocala, FL, 34471, USA
| | - Omeni Osian
- University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, 32827, USA.,HCA Ocala Regional Medical Center, General Surgery Residency Program Faculty, Ocala, FL, 34471, USA.,HCA Ocala Regional Medical Center, Thoracic and Cardiac Surgery, Ocala, FL, 34471, USA
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Affiliation(s)
- Monish S Raut
- Department of Cardiac Anesthesia, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Maheshwari
- Department of Cardiac Anesthesia, Sir Ganga Ram Hospital, New Delhi, India
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Abstract
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.
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Affiliation(s)
- Yan Kong
- From the Department of Medicine Oncology, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei (YK); Postgraduate School, Tianjin Medical University, Heping, Tianjin (HL); Department of Orthopedics, The Fourth Affiliated Hospital of Hebei Medical University, (JW); Department of Respiration, The Second Affiliated Hospital of Hebei Medical University (YC); Department of Cardiac Surgery (WH); and Department of Cardiology, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China (NZ)
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Anesthetic Management of a Case of Posterior Fossa Tumor With An Intracardiac Mass. J Neurosurg Anesthesiol 2015; 28:436-7. [PMID: 26492288 DOI: 10.1097/ana.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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