Systemic Embolization and Myocardial Infarction due to Clinically Unrecognized Left Atrial Myxoma

Abstract

Myxomas are the most common primary tumors of the heart. We report an extraordinary severe case of left atrial myxoma, presenting with stroke, myocardial infarction, and multiple arterial embolism including aorta, splenic and renal arteries, and several peripheral arteries. The patient had previously been diagnosed with systemic vasculitis, a typical but less common finding caused by multiple emboli mimicking vasculitis. The myxoma was removed and atrial septum reconstruction was performed. In summary, early diagnostic differentiation of myxoma from vasculitis is critical, and immediate surgical removal of myxoma is required as the probability of thromboembolic complications increases over time.

Figure 1

Findings obtained upon presentation with non-ST-elevation myocardial infarction. (a) 12-lead ECG on admission. (b–d) Coronary angiograms of left anterior descending artery (LAD; 25° left anterior oblique, 10° caudal angulation), left circumflex artery (LCX; 10° right anterior oblique, 30° caudal angulation), and right coronary artery (RCA; 30° right anterior oblique), revealing no signs of remaining thromboembolus or atherosclerosis. (e, f) Transesophageal echocardiograms, showing a left atrial tumor (arrow) located at the interatrial septum (40° (e) and 70° (f) angulation relative to the transversal plane, resp.). LA: left atrium; LAA: left atrial appendage; Ao: aorta. See text for details.