A rare case of biatrial myxoma in an 11-year-old girl patient with thromboembolic stroke: A case report

Abstract

Introduction: Cardiac myxomas (CM) are benign primary tumors typically found in the left atrium, but biatrial myxomas are exceptionally rare, comprising only 3-5 % of cases. This report highlights the rarity of biatrial myxomas in a young patient, the importance of early recognition due to the risk of thromboembolic events, which can lead to stroke. Excellent surgical intervention is needed to prevent CM recurrences.

Case presentation: An 11-year-old girl presented with sudden onset of left-sided hemiparesis, aphasia, right-sided facial drooping, cephalgia, palpitations, nausea, and intermittent chest pain over the past two months. Laboratory examination revealed anemia and elevated D-Dimer. Echocardiography and cardiac CT demonstrated large masses in the right and left atrium, suggesting myxomas. The patient was diagnosed with biatrial myxomas complicated by thromboembolic stroke.

Clinical discussion: Complete mass evacuation was performed through median sternotomy. Histopathology examination confirmed CM.

Conclusion: This case emphasizes the importance of early detection, detailed examination and surgical intervention of biatrial myxomas, especially in young patients, to prevent and manage life-threatening thromboembolic complications and recurrence of CM. Timely intervention is crucial for ensuring favorable outcomes.

Keywords: Biatrial myxoma; Cardiac myxoma; Cardiac tumor; Case report.

Fig. 1

Preoperative echocardiography showing mass (red arrows) filling RA and LA which connected via atrial septum. LA (left atrium); RA (right Atrium); LV (left ventricle); RV (right ventricle).

Fig. 2

Cardiac CT showing dilated RA and LA with hypodense lesions (red arrows) measuring approximately 3,67 × 4,0 cm in the RA and 2.49 × 3.73 cm in the LA. LA (left atrium); RA (right Atrium).

Fig. 3

Intraoperative finding: gelatinous-like mass (white arrow) filling the whole right atrium.

Fig. 4

A. Gross Examination: benign jelly-like masses, measuring 6 × 5 × 3 cm, and 6 × 2.5 × 2.5 cm with connecting stalk, suggesting myxoma. B. Microscopic examination: Stellate cell within myxoid stroma, complex structures resembling rings around blood vessels.

Fig. 5

Postoperative echocardiography: complete removal of the tumor, no residual shunt from atrial septum. LA(left atrium); RA (right Atrium); LV (left ventricle); RV (right ventricle).