The challenge presented by right atrial myxoma

Abstract

Background and purpose: Right atrial myxoma can be heralded by nonspecific constitutional symptoms-i. e., remittent or lasting fever; weight loss; chronic anemia and general arthralgia-and may escape timely diagnosis until severe complications develop: i. e., pulmonary hypertension due to embolism from fragments originating from the tumor mass, or, by blocking the right atrioventricular ostium, a Budd-Chiari syndrome with acute abdominal pain. Myocardial tamponade and infected right atrial myxomas are reported casuistically. META-ANALYSIS: This study, covering 1,029 patients from 32 reports, represents the most extensive meta-analysis to date of recent publications on patients with intracardiac myxomas who had undergone surgery followed by histological confirmation. 83.0% of myxomas studied were located in the left and 12.7% in the right atrial cavity. Even more rarely, the tumor was present in the left (0.6%) or right (1.7%) ventricles; it was biatrial in 1.3% and multilocular in 0.8% of cases. The age of all reported individuals varied between 1 month and 81 years (mean value of reported mean ages: 50 years); 65% of the patients were female. In a subpopulation of 154 individuals, the fraction of familial cardiac myxomas was 4.5%.

Case study: For a 68-year-old patient with recurrent fever of unknown origin, weight loss, exertional dyspnea, and tachycardia, the authors further describe epidemiology, clinical symptoms, prognosis, and the specific diagnostic and therapeutic challenges involved in the rare case of a right sided atrial myxoma.