Year: 2024
Type: article
Study design: Case Report
Abstract: Heart FailureThe official journal of CardioNerdsCardiac tumors are a relatively rare phenomenon, and most of these are benign.However, given their location, most require prompt surgical treatment as the sequelae of such tumors can be catastrophic.Myxomas constitute about 50% of benign intracardiac tumors and can be particularly large, often nearly obliterating the cavity of the heart that they originate from.Particularly large tumors can cause mass effect on the cardiac chamber, as well as marked hemodynamic derangement including secondary pulmonary hypertension which complicates the surgical management.We present an interesting case of a cardiac myxoma with associated severe pulmonary hypertension requiring careful hemodynamic optimization prior to surgical removal. Case PresentationA 41-year-old man without significant cardiac history presented with abdominal pain, bloating, and dyspnea for the past month.His symptoms were associated with an 18 lb weight gain, bilateral lower extremity edema, paroxysmal nocturnal dyspnea, and three-pillow orthopnea.Recently, he noted feeling pre-syncopal when lifting boxes and while coughing.On further questioning, the patient noted two prior episodes of right upper extremity and left lower extremity paresthesia and paralysis over the past year; both resolved spontaneously.Prior to this, he was an active individual with unlimited exercise tolerance and was able to do a significant amount of walking and lifting for his job.He denied any recent symptoms.The patient's medical history was notable for a one-pack-per-day smoking history for the past 25 years.He also smoked marijuana occasionally.He had not attended primary care for the past two decades.He presented to the emergency department for further evaluation.Given his abdominal distension and bloating, a CT scan of the abdomen was performed, which showed signs of volume overload, with pleural and pericardial effusions, small-volume ascites, and abdominal wall edema.A CT of the chest revealed an 8.5 cm mass originating in the left atrium, prolapsing through the mitral valve causing near-cavity obliteration of the atrium (Figure 1).A 1 cm right lower lung lobe indeterminate mass was also identified. Differential DiagnosisThe differential diagnosis for an intracardiac mass is broad, including both benign and malignant tumors, as well as intracardiac thrombi. 1 The patient's age and the location of the mass are key in narrowing the differential (Figure 2).In our case, the initial chest CT demonstrated a large mass centered in the left atrium, abutting the intraventricular septum, and extending through the mitral valve.Given the location, three main entities were initially considered: thrombus, metastatic disease, and atrial myxoma.
Source: US Cardiology Review
DOI: 10.15420/usc.2024.02
Institutions: Barnes-Jewish Hospital, Washington University in St. Louis
Language: English
Topic: Cardiac tumors and thrombi
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,146
OpenAlex ID: W4404305644