Clinical masks of primary cardiac tumors: a clinical case report

INTRODUCTION: Primary cardiac tumors are rare, 75% of them are benign, half of which are myxomas. Despite histological benignity, untimely diagnosed myxoma can have serious complications. Myxoma is characterized by non-specific symptoms, however, a typical triad of atrial myxoma symptoms is distinguished: (1) symptoms of mitral valve obstruction manifested by heart failure and weakness, (2) symptoms of embolism and (3) systemic manifestations.

AIM: Illustration of the variety of clinical manifestations, discussion of diagnostic difficulties, formation of clinical alertness in the observation of left atrial myxoma.

MATERIALS AND METHODS: Left atrial myxoma in a 49-year-old male patient debuted at the age of 44 with the development of a transient cerebrovascular disorder in the right carotid system manifested by dysarthria and paresis of the facial muscles; at that time, no echocardiographic (EchoCG) examination was conducted. Several years later, the clinical presentation of heart failure manifested: shortness of breath when walking, edema of lower limbs. EchoCG revealed a sizable mass in the left atrium 33 mm × 55 mm fixed to the interatrial septum, prolapsing into the left ventricle and partially stenosing the left atrioventricular opening. Dilation of both atria, of the right ventricle, pronounced pulmonary hypertension, 2-degree regurgitation on the tricuspid valve, 2-degree regurgitation on the pulmonic valve, hydropericardium and hydrothorax on the right were found. The clinical case was also characterized by the developed bilateral thrombosis of the superficial femoral vein with signs of flotation. The development of venous thrombosis in a patient with cardiac myxoma can probably be considered as a systemic manifestation of the tumor disease. After compensation for the heart failure and implantation of a cava filter, the tumor was surgically removed, the morphological picture corresponded to cardiac myxoma with hemorrhages of various ages.

CONCLUSION: The case demonstrates the need for performing EchoCG in a transient ischemic attack, in ischemic stroke, to screen for intracardiac masses capable of frustrating cerebral circulation by cardioembolic mechanism, especially at a young age in the absence of other cardiovascular risk factors. The clinical picture consistently showed all the symptoms of the classic triad of cardiac myxoma: embolic syndrome, symptoms of mitral valve obstruction and systemic manifestations. The prognosis for patients with cardiac myxoma depends on the severity of thromboembolic syndrome and severity of heart failure. Timely diagnosis and surgical removal of cardiac myxoma provide a favorable prognosis.