A case report of left atrial myxoma-induced acute myocardial infarction and successive stroke

Abstract

Rationale: Left atrial myxoma is a common primary cardiac tumor, however, due to poor image quality or atypical myxoma images, it is often misdiagnosed by echocardiograph. A case of left atrial myxoma being misdiagnosed as a thrombus, which successively caused acute myocardial infarction (AMI) and stroke, is very rare. Contrast-enhanced echocardiography can play an important role in definitive diagnosis.

Patient concerns: A 44-year-old woman was diagnosed AMI because of chest pain with no significant stenosis in the coronary arteries. One month later, the patient was suddenly found unconscious, magnetic resonance imaging (MRI) showed acute multiple cerebral infarctions in the left cerebral hemisphere.

Diagnoses: Left atrial myxoma, acute myocardial infarction, and stroke.

Interventions: The patient was given a cardiac surgery for tumor resection, the mass was surgically removed and histopathologic findings showed myxoma.

Outcomes: After several weeks of rehabilitation, the patient was able to resume daily activities without chest discomfort or dyspnea. One year later, echocardiography showed no recurrence of left atrial myxoma. The patient generally was in good condition.

Lessons: Although myxoma is mostly benign, this patient occurred AMI and stroke because of misdiagnosis. Comprehensive assessments should be performed with multiple imaging methods for cardiac masses. If necessary, contrast-enhanced echocardiography should be used to clarify, so as not to delay the timing of surgery and bring potential risk of death to patients.

Figure 1

(A) Coronary angiography showed the distal branch of the LCX was thrombo-occluded with thrombolysis (yellow arrow). (B) CAG showed the blood flow recovery in the LCX. CAG = coronary angiography, LCX = left circumflex artery.

Figure 2

(A, B) MRI showed multiple fresh cerebral infarctions in the left frontal temporal lobe, basal ganglia, and radiation crown. (C) MRA showed the left middle cerebral artery was slender and distal branches were reduced. MRA = magnetic resonance angiography, MRI = magnetic resonance imaging.

Figure 3

(A) TOE revealed left atrial strong echoic mass (yellow arrow); (B) TEE X-plane showed the hyperechoic mass in the left atrium, which was wide based and pedicle-less and attached to the foramen ovale at the interatrial septum. (C) Contrast-enhanced echocardiography showed absence of contrast agent filling in the left atrial abnormal mass and exploration of scattered and dotted contrast media within the mass. TEE = transesophageal echocardiography, TOE = transthoracic echocardiography.

Figure 4

(A) Surgical specimen of the completely resected atrial myxoma. (B) Pathological results confirmed left atrium myxoma.