A rare case of atrial myxoma with biatrial extension

Acute Lower Limb Ischaemia as a Presenting Sign of Atrial Myxoma: Case Report and Scoping Review of the Literature

Objective

Cardiac myxomas (CMs) are the most common primary cardiac tumour in adults. They are a rare cause of peripheral embolisation and may present as acute lower limb ischaemia (ALI). A scoping review was undertaken and a case of ALI due to CM embolisation is presented in this paper.

Methods

MEDLINE, Scopus, and Embase were systematically searched for studies reporting data on ALI as a presentation of CM embolisation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed.

Results

A healthy 26 year old female presented to the emergency department with bilateral ALI. Urgent bilateral aorto-iliac embolectomy and distal embolectomy of the left femoropopliteal axis were performed. The retrieved embolic material exhibited a yellowish appearance and jelly like consistency, and histological analysis provided a diagnosis of a myxomatous embolus. Transoesophageal echocardiography confirmed the left atrial origin of a myxomatous tumour, but the residual mass was considered too small for further excision. At a two year clinical follow up, the patient was alive and well without recurrence. Between 1989 and 2023, 59 patients with ALI due to CM embolisation were identified in the literature. An in hospital mortality rate of 12.1% (n = 7) was reported, while the in hospital complication and re-intervention rates were 34.5% (n = 20) and 27.6% (n = 16), respectively. No post-discharge deaths, complications, or re-interventions were reported; fasciotomies were the most reported (n = 10). Post-discharge follow up was reported in 22 (37.3%) patients. Mean follow up was 18.0 ± 18.8 months (range 1-120), and 86.4% of patients (n = 19) were alive and well at last follow up.

Conclusion

This review and the associated case report underline that CM embolisation should be considered in healthy young patients presenting with cryptogenic ALI. Early transoesophageal echocardiography and histological analysis of the retrieved embolus are recommended to minimise misdiagnosis in these populations.

Giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava

Cardiac myxomas are the most common type of benign cardiac tumors and most of them occur in the left atrium but the biatrial myxoma is uncommon. We present a rare case of giant biatrial myxoma nearly obstructing the orifice of the inferior vena cava. A 58-year old woman presented with exertional dyspnea and intermittent chest discomfort. The non-pedunculated tumor involved most of the interatrial septum and extended from the orifice of the inferior vena cava to the displaced mitral annulus and the lower left pulmonary vein. The resected specimen weighed 76 gram and measured 80 × 40 × 30 mm. She did not complain of dyspnea or show any sign of recurrence by echocardiography during the 2-year follow-up period.