Posters
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Discipline Track
Clinical Science
Abstract
Background: Myxomas are the most common primary cardiac neoplasms and are predominantly located in the left atrium, accounting for approximately 80% of cases. Clinical manifestations can vary widely, ranging from asymptomatic to severe, with potential embolic or obstructive symptoms. Diagnosis is typically made through echocardiography, although CT and MRI can also be useful diagnostic tools. The primary treatment is surgical resection; however, long-term follow-up is essential due to the risk of recurrence, which may occur up to 10 years after the initial surgery.
Case presentation: A 54-year-old female patient with a history of a 5x3x2 cm left atrial myxoma diagnosed four years ago, surgically treated without any complications, presented with a sudden onset of a language disorder characterized by motor aphasia. This condition resolved spontaneously without leaving any sequelae. For this reason, she decided to seek medical evaluation, during which an echocardiographic scan was performed, revealing a left intracavitary mass of 20 x 14 mm. Given these findings, she was referred to our clinic. Upon admission, the patient was conscious and calm, appearing her stated age. Oral mucosa was hydrated, and the neck was centrally positioned and cylindrical, without jugular venous distention. Hepatojugular reflux was not observed, and no adenopathy was palpable. Cardiac sounds were rhythmic, with good tone and intensity; no murmurs were auscultated, and there was no presence of S3 or S4 sounds, nor was there a pericardial friction rub. The rest of the examination was normal. The electrocardiogram was normal, the chest X-ray was normal, and the admission laboratory results showed no abnormalities. Transthoracic and transesophageal echocardiograms were performed, revealing a nodular image in the left atrium attached to the septum. Given the patient's history and the findings, a recurrence of myxoma was suspected, prompting the initiation of a surgical resection protocol. The surgery was carried out without complications, with resection of the tumor and the specimen sent to pathology for analysis. The histopathological report confirmed the diagnosis of cardiac myxoma.
Conclusions: Recurrent myxoma is rare, occurring in 1-3% of operated patients. Possible causes of recurrence include incomplete resection, proliferation of a second tumor focus, or intracardiac implantation of the original tumor.
The clinical presentation of myxomas is highly variable and nonspecific, depending on the location, size, and morphology. Dyspnea is the most prevalent symptom, reported in 50% to 80% of patients, while embolic events, including cerebrovascular accidents, occur in 18%. Constitutional symptoms are present in 7% of cases. Atrial fibrillation is associated with larger myxomas. Approximately 35.6% of patients remain asymptomatic.
The risk of recurrence even after surgical resection requires the need for regular follow up with echocardiography post resection. There is no specific guidelines that directly addresses the frequency of echocardiograms in patients who undergone surgical resection of a myxoma, however, a reasonable approach might be to follow the patient closely in the first year post-surgery, with echocardiograms every 6 months, then annually for the next few years, and thereafter based on the patient´s clinical status and risk for recurrence.
Presentation Type
Poster
Recommended Citation
Martinez Borrego, Abdel; Moran Herrera, Benito; and Flores, Eduardo, "Recurrent Atrial Myxoma and Transient Ischemic Atack" (2024). Research Colloquium. 69.
https://scholarworks.utrgv.edu/colloquium/2024/posters/69
Recurrent Atrial Myxoma and Transient Ischemic Atack
Included in
Recurrent Atrial Myxoma and Transient Ischemic Atack
Background: Myxomas are the most common primary cardiac neoplasms and are predominantly located in the left atrium, accounting for approximately 80% of cases. Clinical manifestations can vary widely, ranging from asymptomatic to severe, with potential embolic or obstructive symptoms. Diagnosis is typically made through echocardiography, although CT and MRI can also be useful diagnostic tools. The primary treatment is surgical resection; however, long-term follow-up is essential due to the risk of recurrence, which may occur up to 10 years after the initial surgery.
Case presentation: A 54-year-old female patient with a history of a 5x3x2 cm left atrial myxoma diagnosed four years ago, surgically treated without any complications, presented with a sudden onset of a language disorder characterized by motor aphasia. This condition resolved spontaneously without leaving any sequelae. For this reason, she decided to seek medical evaluation, during which an echocardiographic scan was performed, revealing a left intracavitary mass of 20 x 14 mm. Given these findings, she was referred to our clinic. Upon admission, the patient was conscious and calm, appearing her stated age. Oral mucosa was hydrated, and the neck was centrally positioned and cylindrical, without jugular venous distention. Hepatojugular reflux was not observed, and no adenopathy was palpable. Cardiac sounds were rhythmic, with good tone and intensity; no murmurs were auscultated, and there was no presence of S3 or S4 sounds, nor was there a pericardial friction rub. The rest of the examination was normal. The electrocardiogram was normal, the chest X-ray was normal, and the admission laboratory results showed no abnormalities. Transthoracic and transesophageal echocardiograms were performed, revealing a nodular image in the left atrium attached to the septum. Given the patient's history and the findings, a recurrence of myxoma was suspected, prompting the initiation of a surgical resection protocol. The surgery was carried out without complications, with resection of the tumor and the specimen sent to pathology for analysis. The histopathological report confirmed the diagnosis of cardiac myxoma.
Conclusions: Recurrent myxoma is rare, occurring in 1-3% of operated patients. Possible causes of recurrence include incomplete resection, proliferation of a second tumor focus, or intracardiac implantation of the original tumor.
The clinical presentation of myxomas is highly variable and nonspecific, depending on the location, size, and morphology. Dyspnea is the most prevalent symptom, reported in 50% to 80% of patients, while embolic events, including cerebrovascular accidents, occur in 18%. Constitutional symptoms are present in 7% of cases. Atrial fibrillation is associated with larger myxomas. Approximately 35.6% of patients remain asymptomatic.
The risk of recurrence even after surgical resection requires the need for regular follow up with echocardiography post resection. There is no specific guidelines that directly addresses the frequency of echocardiograms in patients who undergone surgical resection of a myxoma, however, a reasonable approach might be to follow the patient closely in the first year post-surgery, with echocardiograms every 6 months, then annually for the next few years, and thereafter based on the patient´s clinical status and risk for recurrence.