Unusual Presentation of Atrial Myxoma: A Case Report and Review of the Literature

Jaravaza, Diana Rufaro ; Lalla, Usha ; Zaharie, Stefan Dan ; De Jager, Louis Johann (2021-05-03)

Academic Paper

Background: Although rare, atrial myxoma is the most common benign cardiac tumor. The recognized triad of presenting symptoms relates to constitutional, embolic, and obstructive effects produced by the tumor. However, the pre¬sentation may be non-specific and mimic other diseases, confounding diagnosis. Case Report: A middle-aged woman presented with wheezing and shortness of breath. With a strong background smok¬ing history, the initial impression was that of acute bronchospasm. She however deteriorated rapidly, with de¬creased consciousness and cardiac arrest requiring resuscitation. Despite intensive care management, she died within 1 day of admission. Autopsy revealed a previously undiagnosed left atrial myxoma with coronary and systemic embolization. Conclusions: This case highlights an unusual presentation of atrial myxoma, resulting in fatal simultaneous embolization to the coronary and cerebral arteries. This simultaneous embolic presentation is not common, but the potential consequences are serious. This report also demonstrates that the presentation of a left-sided atrial myxoma with cardiac asthma can mimic respiratory disease and confound diagnosis. In adult patients without a histo¬ry of chronic respiratory disease, the possibility of cardiac asthma should always be entertained. Furthermore, the importance of considering atrial myxoma as a cause for cardiac asthma is emphasized. The use of trans¬thoracic echocardiogram in aiding the rapid diagnosis of atrial myxoma is recommended. Finally, the contin¬ued acknowledgement of the important contribution the academic autopsy makes in complementing and im-proving clinical practice remains imperative.

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