Left Atrial Myxoma Presenting as Lateral Medullary (Wallenberg's) Syndrome

Abstract

Myxomas are benign, primary tumors of the heart. Atrial myxomas can present with a variety of clinical features including dyspnea, orthopnea, pulmonary edema, and pulmonary or systemic emboli. Constitutional symptoms such as fever and weight loss may also be present. We report the case of a young female presenting with headache, facial numbness, and vertigo, who was found to have a posterolateral medullary stroke secondary to a large left atrial cardiac myxoma.

Figure 1

MRI of the brain with and without contrast showing focal restricted diffusion within the left posterolateral aspect of the medulla with associated focal heterogeneous T2 hyperintense signal, indicative of an evolving focal subacute cerebrovascular accident. Alternatively, this finding may represent an acute-subacute focus of demyelination in the proper clinical setting.

Figure 2

Transthoracic echocardiogram. There is a large, 5.7 cm (L) × 1.9 cm (W), mobile mass on the left side of the interatrial septum; the appearance is consistent with myxoma (echocardiographic contrast reveals vascularity of the mass). The mass travels along with the anterior mitral leaflet and plops in and out of the left ventricle. Transvalvular velocity of the mitral valve is within the normal range, and there is no evidence of stenosis. Left ventricular ejection fraction was in the range of 55% to 60%.