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Review
. 2018 Nov 28;18(1):373.
doi: 10.1186/s12887-018-1313-6.

Rare presentation of an atrial myxoma in an adolescent patient: a case report and literature review

Eduardo Macias  1 , Elizabeth Nieman  2 , Kentaro Yomogida  3 , Orlando Petrucci  4 , Cylen Javidan  5 , Kevin Baszis  3 , Shafkat Anwar  6
Affiliations
Review

Rare presentation of an atrial myxoma in an adolescent patient: a case report and literature review

Eduardo Macias et al. BMC Pediatr. .

Abstract

Background: Cardiac tumors are uncommon in the pediatric population. When present, cardiac manifestations stem from the tumor causing inflow or outflow obstruction. While common in adults, cardiac myxomas presenting with generalized systemic illness or peripheral emboli especially with no cardiac or neurological symptoms are rare in children.

Case presentation: We report a case of a previously healthy adolescent girl who presented with a 6-month history of constitutional symptoms and a purpuric rash with no cardiac or neurologic symptoms, found to have a cardiac myxoma.

Conclusions: A vasculopathic rash in the setting of atrial myxomas has been shown be a precursor to significant morbidity and mortality. Due to the rarity of this entity, the time elapsed from onset of non-cardiac symptoms until diagnosis of a myxoma is usually prolonged with interval development of irreversible neurological sequelae and death reported in the literature. Therefore, we highlight the importance of including cardiac myxomas and paraneoplastic vasculitis early in the differential diagnosis for patients presenting with a purpuric rash and systemic symptoms.

Keywords: Embolic phenomena; Myxoma; Neurological sequelae; Paraneoplastic vasculitis; Purpuric rash; Systemic symptoms.

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Conflict of interest statement

Ethics approval and consent to participate

Case Reports are not required to have Institutional Review Board approval, and thereby ethics approval at Washington University at Saint Louis School of Medicine.

Consent for publication

Our patient and patient’s father signed a written consent for publication of her clinical information and her pictures according to Washington University at Saint Louis School of Medicine’s internal policies and statutes.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Skin findings at presentation, including retiform patches, purpura and duskiness of right 2nd toe. Left foot dorsum with biopsy sutures in place
Fig. 2
Fig. 2
Echocardiographic image in the apical four chamber view shows a pedunculated mass attached to the atrial septum, red arrow. Cardiac magnetic resonance imaging stud, the axial four-chamber view shows the left atrial mass. Tissue characterization with T1 and T2 weighted images, first pass gadolinium perfusion and delayed enhancement sequences was highly suggestive of a myxoma
Fig. 3
Fig. 3
3.5 X 3.5 X 2.5 lobular, gelatinous, myxomatous mass following resection from left atrium in the operating room. Microscopic examination substantiated the diagnosis of a myxoma
Fig. 4
Fig. 4
Resolution of purpura with minimal residual erythema at the right second toe 3 weeks after resection
Fig. 5
Fig. 5
Timeline
See this image and copyright information in PMC

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