Korean Circ J.  2008 Nov;38(11):622-626. 10.4070/kcj.2008.38.11.622.

Probable Left Atrial Myxoma Presenting as Concurrent Cerebral and Myocardial Infarctions

• Jeon U
• Cho YS
• Kim DH
• Park SH
• Lee SJ
• Shin WY
• Jin DK
• Lee SW

• KMID: 2225712
• DOI: http://doi.org/10.4070/kcj.2008.38.11.622

Abstract

Concurrent cerebral and coronary artery embolization is a theoretically possible, but extremely rare complication of an atrial myxoma. We present a paitent with a left atrial mass (a probable myxoma) who presented with concurrent cerebral and myocardial infarctions due to emboli of tumor origin. An 84-year-old woman presented with an acute cerebral infarction of the middle cerebral artery territory. Several hours after admission, she complained of chest pain consistent with a myocardial infarction. Transthoracic and transesophageal echocardiographic studies revealed the presence of a large, mobile, heteroechoic mass with a few daughter nodules in the left atrium, compatible with a myxoma. Coronary angiography disclosed subtotal occlusion of the ramus intermedius branch and visible tumor vascularization adjacent to the right coronary artery. With medical treatment, including anticoagulation, the patient was stabilized and had an uneventful clinical course for the ensuing 6 months since discharge.

Keyword

Myxoma; Myocardial infarction; Cerebral infarction

MeSH Terms

Aged, 80 and over
Cerebral Infarction
Chest Pain
Coronary Angiography
Coronary Vessels
Female
Heart Atria
Humans
Middle Cerebral Artery
Myocardial Infarction
Myxoma
Nuclear Family

Figure

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  Fig. 1 Initial ECG showed intermittent ventricular premature complexes and diffuse non-specific ST segment changes. ECG: electrocardiogram.

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  Fig. 2 Initial brain MR images. A: T2 flair MRI image showing left MCA territory infarction. B: brain MR angiogram showing no significant stenosis of the cerebral artery. MCA: middle cerebral artery.

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  Fig. 3 Transthoracic and transesophageal echocardiographic studies. A: transthoracic echocardiogram (apical four-chamber view) revealing the presence of a large mass with heterogenic echogenicity in the left atrium, possibly indicative of atrial myxoma. B: transesophageal echocardiogram of the mass shows irregular surface, with a polypoid nodule.

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  Fig. 4 Coronary angiography in right anterior oblique view (A) and enlarged image (B) showing subtotal occlusion of ramus intermedius with thrombi-like hazziness (arrows).

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  Fig. 5 Visible feeding vascularization originating from the right coronary artery (arrows), strongly suggestive of cardiac myxoma.

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