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Atrial myxomas are rare cardiac tumors that usually present with diverse, unrelated symptoms. Conversely, heart failure (HF) is a common cardiac disorder that is mostly caused by uncontrolled systemic hypertension. It is a progressive cardiac disease that is managed with guideline directed medical therapy (GDMT). We present the case of a farmer who presented with typical symptoms of HF. Echocardiography however revealed an unusual cause of his symptoms—a huge mass in his left atrium (LA) prolapsing through the mitral valve, causing functional mitral stenosis. The mass is suspected to be an atrial myxoma. Surgical excision of this mass is proposed as the cure, which will obviate the need for continuous use of GDMT. This case report and literature review bring to fore the mechanisms by which atrial myxoma can cause HF and the other varied clinical presentations of atrial myxomas.

We present the case of a 64-year-old man who was incidentally found to have a left atrial mass in the vicinity of the left atrial appendage. Despite adequate anticoagulation for suspected thrombus for 6 months, the appearances of the mass remained unchanged. Surgical resection was recommended to reduce the risk of embolisation and to establish a histopathological diagnosis. Despite our initial suspicions of this being a myxoma the mass was ultimately confirmed to represent a rare papillary fibroelastoma occurring on the endocardial surface of the left atrium. The current report details the multimodality imaging of this phenomenon along with the diagnostic dilemma this unusual left atrial mass initially posed. [ABSTRACT FROM AUTHOR]

Purpose: Carney complex (CNC) is a rare, autosomal dominant syndrome, most commonly caused by PRKAR1A gene mutations and characterized by pigmented skin and mucosal changes with multiple endocrine and non-endocrine tumours. This case report highlights the diagnostic challenges associated with CNC in a patient with multiple neoplasms and a complex medical history, including cortisol-producing adrenal adenoma, breast cancer, melanoma, and atrial myxoma. Methods: We report the case of a 41-year-old woman with a medical history of left adrenalectomy for cortisol producing adenoma (2005) with no sign of adrenal insufficiency at follow-up, right mastectomy for BRCA1/2 negative carcinoma (2013) and left parotid BRAF-V600E wild-type melanoma (2019), treated with nivolumab adjuvant therapy. In August 2019, following the fifth nivolumab administration, the patient developed central hypocortisolism due to iatrogenic hypophysitis, confirmed by brain MRI and properly treated with oral hydrocortisone. Nivolumab was discontinued due to the patient's decision. In October 2020 and April 2021, the patient had ischaemic strokes, requiring systemic thrombolysis. Echocardiographic examination then revealed a left atrial mass, with histological finding of myxoma. Results: Given the rarity of this neoplasm and the suspicion of a syndromic disorder, a genetic evaluation was conducted, which confirmed a PRKAR1A gene mutation and the diagnosis of Carney complex. Conclusion: This case illustrates the diagnostic challenges in CNC, especially in patients with multiple tumourous manifestations and a wide spectrum of life-threatening clinical presentations. It underscores the importance of a multidisciplinary approach to diagnose and manage rare diseases, improving patient outcomes through timely genetic testing and coordinated care. [ABSTRACT FROM AUTHOR]

Abstract Background The presence of cardiac myxoma in the right atrium (RA) is rare. There is limited knowledge regarding the clinical symptoms and diagnosis of RA myxoma. This systematic review aimed to provide a summary of the clinical and laboratory characteristics, electrocardiogram (ECG) findings, and outcome previous cases with RA myxoma. Methods A comprehensive search was conducted in PubMed, Web of Science, and Scopus to identify relevant studies. Inclusion criteria were case reports and case series written in English that provided sufficient data on the manifestation of RA myxoma. Descriptive statistics were used for quantitative analysis. Results The search identified 619 patients from 480 eligible studies. The patient’s mean age was 45.7 ± 17.6 years, and 55.4% of cases were female. The most common clinical manifestations of RA myxoma were cardiac, systemic, and neurologic manifestations which reported in 77.0%, 34.8%, and 21.1% of cases, respectively. Besides, 11.7% of RA myxoma were asymptomatic. ECG findings revealed normal in 39.4% reported cases. The ECG abnormalities included tall or peaked P-wave, RA and LA enlargement (19.2%), abnormal T-wave (14.0%), sinus tachycardia (11.8%), and incomplete or complete RBBB (11.2%). Echocardiography remained the diagnostic method in a majority of the cases. The mortality rate of RA myxoma was low (9.2%) during the follow-up. Conclusions This systematic review provides a comprehensive summary of the clinical and laboratory manifestations and outcomes of RA myxoma, contributing to the existing knowledge on this rare cardiac tumor.

Abstract Background The occurrence of cerebral aneurysm in a case of cardiac myxoma is rare with less than 60 cases reported worldwide. The course of management is still debatable given its rarity. We present a case of multiple intracranial aneurysms secondary to atrial myxoma in a young lady with a brief review of the literature. Case presentation A young lady in her late 30s with a history of right middle cerebral artery territory stroke eight years ago presented with gradually progressive symptoms in the form of holocranial headache, inattention and forgetfulness for the last few years. On neuroimaging, she was found to have multi-territorial lacunar infarcts and multiple intracranial artery aneurysms which was confirmed with a digital subtraction angiogram. A cardiac evaluation revealed a left atrial myxoma. The aetiology of subcortical cognitive decline and intracranial aneurysms was attributed to the myxoma with secondary myxomatous embolism. Other secondary causes were ruled out. She is being followed up medically after resection of the myxoma. Conclusion Intracranial aneurysms are rare complications of cardiac myxoma which may present before, concurrent or many years after diagnosis of the myxoma. Nonspecific neurological complaints occasionally are the ominous signs of intracranial aneurysms which mandate a low threshold for neuroimaging in a case of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-ups are critical. Learning Points Intracranial aneurysms are rare complications of cardiac myxoma that may present before, concurrent or many years after diagnosis of the myxoma. Special attention must be given to nonspecific neurological complaints with a low threshold for neuroimaging in those with a prior history of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-up including conventional angiography and/or magnetic resonance imaging is critical.

Background: The occurrence of cerebral aneurysm in a case of cardiac myxoma is rare with less than 60 cases reported worldwide. The course of management is still debatable given its rarity. We present a case of multiple intracranial aneurysms secondary to atrial myxoma in a young lady with a brief review of the literature. Case presentation A young lady in her late 30s with a history of right middle cerebral artery territory stroke eight years ago presented with gradually progressive symptoms in the form of holocranial headache, inattention and forgetfulness for the last few years. On neuroimaging, she was found to have multi-territorial lacunar infarcts and multiple intracranial artery aneurysms which was confirmed with a digital subtraction angiogram. A cardiac evaluation revealed a left atrial myxoma. The aetiology of subcortical cognitive decline and intracranial aneurysms was attributed to the myxoma with secondary myxomatous embolism. Other secondary causes were ruled out. She is being followed up medically after resection of the myxoma. Conclusion: Intracranial aneurysms are rare complications of cardiac myxoma which may present before, concurrent or many years after diagnosis of the myxoma. Nonspecific neurological complaints occasionally are the ominous signs of intracranial aneurysms which mandate a low threshold for neuroimaging in a case of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-ups are critical. Learning Points Intracranial aneurysms are rare complications of cardiac myxoma that may present before, concurrent or many years after diagnosis of the myxoma. Special attention must be given to nonspecific neurological complaints with a low threshold for neuroimaging in those with a prior history of cardiac myxoma. Given the absence of definitive risk factors and unclear natural history, clinical and radiological follow-up including conventional angiography and/or magnetic resonance imaging is critical. [ABSTRACT FROM AUTHOR]

Background: The presence of cardiac myxoma in the right atrium (RA) is rare. There is limited knowledge regarding the clinical symptoms and diagnosis of RA myxoma. This systematic review aimed to provide a summary of the clinical and laboratory characteristics, electrocardiogram (ECG) findings, and outcome previous cases with RA myxoma. Methods: A comprehensive search was conducted in PubMed, Web of Science, and Scopus to identify relevant studies. Inclusion criteria were case reports and case series written in English that provided sufficient data on the manifestation of RA myxoma. Descriptive statistics were used for quantitative analysis. Results: The search identified 619 patients from 480 eligible studies. The patient's mean age was 45.7 ± 17.6 years, and 55.4% of cases were female. The most common clinical manifestations of RA myxoma were cardiac, systemic, and neurologic manifestations which reported in 77.0%, 34.8%, and 21.1% of cases, respectively. Besides, 11.7% of RA myxoma were asymptomatic. ECG findings revealed normal in 39.4% reported cases. The ECG abnormalities included tall or peaked P-wave, RA and LA enlargement (19.2%), abnormal T-wave (14.0%), sinus tachycardia (11.8%), and incomplete or complete RBBB (11.2%). Echocardiography remained the diagnostic method in a majority of the cases. The mortality rate of RA myxoma was low (9.2%) during the follow-up. Conclusions: This systematic review provides a comprehensive summary of the clinical and laboratory manifestations and outcomes of RA myxoma, contributing to the existing knowledge on this rare cardiac tumor. [ABSTRACT FROM AUTHOR]

To date, no significant association has been reported between atrial septal defects (ASD) and cardiac myxomas. This study reports a 56-year-old woman with cardiac myxoma following transcatheter closure of ASD. She presented with a 3-month history of recurrent dizziness, vertigo, palpitations, and generalized weakness after undergoing ASD occlusion a year earlier. Echocardiography and cardiac computed tomography scans identified a large, mobile mass (7.2 cm × 2.8 cm) in the left atrium, protruding through the mitral valve. The patient underwent median sternotomy and pericardiotomy, and the histopathological examination confirmed the diagnosis of atrial myxoma. The current case illustrates the challenges in determining whether an atrial mass is a benign myxoma or a dangerous thrombus. While there is no definitive link between the implantation of an ASD closure device and the formation of a myxoma, the emergence of this tumor is a potential occurrence. [ABSTRACT FROM AUTHOR]

Acute ischemic stroke (AIS) is a common complication of atrial myxoma (AM), and most emboli originate from a thrombus attached to the surface of the myxoma, with occasional shedding of tumor fragments leading to stroke. Clinical manifestations of AM include mitral valve obstruction, systemic embolism, and weakness. However, neurological deficits and other nonspecific manifestations may mask the presence of AM. The surgical resection is the most effective treatment for these conditions. However, the main problem is the lack of consensus regarding the prevention and treatment of stroke complicated by myxoma during the perioperative period. This study aims to improve the diagnosis and treatment of AM and the associated AIS. Here, we report the case of a 27-year-old patient with AM who presented with chest pain, palpitations, and sudden dizziness and had a stroke under anticoagulant treatment during the admission period. We also reviewed and summarized the clinical presentations and characteristics of similar previously reported cases. Our review emphasized the importance of early diagnosis and appropriate perioperative management of AM and its associated AIS.

The article in Acta Cardiologica discusses a case of a 60-year-old female with chest tightness, where a left atrial mass was initially misdiagnosed as a myxoma but was later identified as a thrombus through advanced imaging techniques. The patient underwent mitral valve replacement and left atrial thrombectomy, with histopathological analysis revealing chronic valvulitis. The article emphasizes the importance of timely and accurate imaging diagnosis in distinguishing between thrombus and myxoma in cases of left atrial masses, particularly in patients with rheumatic heart disease. [Extracted from the article]

Myxomas are the most common type of benign cardiac tumors, and the right atrium is the second most common location among them, with an incidence ranging from 8.6% to 20% of all cardiac myxomas. Herein, we described a rare case of right atrial myxoma originating from the inferior vena cava orifice. In this case, main pulmonary artery cannulation and moderate hypothermic circulatory arrest were helpful to obtain a clear and simple view of the operative field without blood, which led to complete resection of the tumor with safety and better outcomes with no future recurrence. [ABSTRACT FROM AUTHOR]

Atrial myxoma is a rare primary tumour of the heart that typically arises from the left atrium. Patients typically present with obstructive symptoms such as dyspnoea, but constitutional and embolic symptoms can be seen as well. Gastrointestinal symptoms in the absence of embolisation are rarely reported in the literature. Our case presents a 55-year-old female who was found to have a large left atrial myxoma after presenting with gastrointestinal symptoms, which resolved upon resection of the tumour. This case illustrates that atrial myxomas can have an atypical presentation with gastrointestinal symptoms, which could be related to inflammation of gastric mucosa from interleukin-6 produced by the tumour cells. Careful history-taking followed by early detection and prompt treatment is important as atrial myxomas can lead to potentially devastating complications.

Atrial myxomas are rare cardiac tumors. It has to be surgically resected early when diagnosed, due to possible complications such as intracardiac obstruction, embolus, and metastasis. It becomes more challenging when found as an incidental finding in routine evaluation for a case of a ruptured aneurysm. Atrial myxoma is a common cause of ischemic and hemorrhagic strokes, but in 10%–15% of cases, it is associated with the development of metastatic intracranial aneurysms which is a rare complication of myxomatous emboli. We report the case of a 42-year-old female patient presented with subarachnoid hemorrhage, posted for the repair of left paraclinoid internal carotid artery aneurysm under general anesthesia with left interatrial septum myxoma.

Merga Daba Mulisa,1 Shalom Kassahun Bekele,1 Sisay Bekele Woldemichael,2 Sitota Ganjula Gaito,3 Fadil Nuredin Abrar,4 Betelhem Gebreamlak Hailu4 1Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Cardiothoracic Unit, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia; 3Cardiology Unit, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia; 4Department of Pathology, School of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Merga Daba Mulisa, Department of Internal Medicine, School of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251912684411, Email mergadaba1995@gmail.comAbstract: Left atrial masses are commonly caused by atrial myxomas and metastatic tumors. Primary cardiac sarcomas are rare. Patients present with symptoms related to the tumor location. There are only a few case reports on this rare disease. We report the case of a 17 years old male patient presented with shortness of breath for 2-month duration. Echocardiography revealed a left atrial mass that was later surgically excised and histopathology confirmed a primary cardiac sarcoma. We discuss the diagnostic and therapeutic challenges encountered in the management of this rare disease. To the best of our knowledge, this is the first case reported in East Africa.Keywords: primary cardiac sarcoma, atrial mass, atrial myxoma

Primary cardiac tumours are uncommon, and approximately 90% of them, in both children and adults, are benign. Primary tumours are less prevalent than secondary malignancies that spread to the heart. The subtle and non specific nature of the clinical signs could cause a delay in diagnosis, as well as surgical treatment. Although epidemiology and multimodality imaging approaches are helpful, the definitive diagnosis often necessitates histologic evaluation, and histological characterisation continues to be the gold standard in diagnostics. Herein the authors described four (two males and two females) cases of intriguing primary cardiac tumours. All the cases were diagnosed to have a cardiac mass/clot by Echocardiography (Echo), and the cases underwent tumour excision. Histopathological analysis revealed three benign cases diagnosed as atrial myomas, and one malignant case diagnosed as high-grade spindle cell sarcoma, specifically rhabdomyosarcoma. Immunohistochemistry (IHC) was required for the definitive diagnosis of the malignant patient. All the patients were followed-up for a period of one year. All benign cases were symptom-free, while the patient who had rhabdomyosarcoma expired. The aim of the present case series was to highlight the importance of histopathological examination, as well as the prognosis of cardiac tumours.

Intracardiac tumour is rare, and intracardiac myxoma is the most common intracardiac tumour of the heart. The majority of these tumours arise at the left and right atrium, and a presentation of such a tumour other than the mentioned is atypical and very rare. Due to the rare occurrence, clinicians often misdiagnose it as infective endocarditis especially if the tumour is located near the valves and causing outflow gradient stenosis on echocardiography. A multi-modal cardiac imaging and a multi-disciplinary approach are paramount to make a correct diagnosis and treatment strategies. We would like to report a rare case of a right ventricular myxoma of a young girl, who was initially treated with infective endocarditis, which turned out to be a rare atypical Right ventricular myxoma, which was then surgically excised. The patient was successfully discharged after 3 years of follow up echocardiography showed free of tumour recurrence. [ABSTRACT FROM AUTHOR]

Atrial myxomas are rare cardiac tumors. It has to be surgically resected early when diagnosed, due to possible complications such as intracardiac obstruction, embolus, and metastasis. It becomes more challenging when found as an incidental finding in routine evaluation for a case of a ruptured aneurysm. Atrial myxoma is a common cause of ischemic and hemorrhagic strokes, but in 10%-15% of cases, it is associated with the development of metastatic intracranial aneurysms which is a rare complication of myxomatous emboli. We report the case of a 42-year-old female patient presented with subarachnoid hemorrhage, posted for the repair of left paraclinoid internal carotid artery aneurysm under general anesthesia with left interatrial septum myxoma. [ABSTRACT FROM AUTHOR]

Myxomas are tumors that occur due to uncontrolled proliferation of mesenchymal cells. Cardiac myxomas although very rare, are still the most common primary tumor of heart. Cardiac myxomas have a prevalence of 0.03% in the general population. They can have a variety of clinical presentations with obstructive cardiac symptoms, constitutional symptoms and symptoms due to embolism to other body parts chief among them. CNS embolism with stroke is among the rarest clinical presentation of cardiac myxomas. Our article portrays a case of cardiac myxomas that initially resulted in episodes of dyspnea and syncope and eventually led to recurrent episodes of transient ischemic attack and stroke. Case was confirmed by transesophageal echocardiography and managed surgically by medial sternotomy. Myxoma, a benign primary cardiac tumor is itself a rare occurrence, embolization of myxoma leading to multiple strokes is an atypical clinical presentation. Our report would be a valuable addition to the already existing literature.

Background and Objectives: Pulmonary hypertension arise from an increase in resistance within the pulmonary vasculature, leading to consequences such as hypoxia, hypoxemia, and right heart failure. The underlying causes of this increased resistance are diverse and classified using the World Health Organization (WHO) classification system. One specific etiology is chronic thromboembolic pulmonary hypertension or simply CTEPH. Case presentation: This case report focuses on a 42-year-old African American cisgender female who presented with a deep vein thrombosis in her left leg and shortness of breath. Further investigation revealed a large mass in her right atrium during a bedside echocardiogram, suggestive of a possible right atrial myxoma. This patient subsequently underwent median sternotomy with thrombectomy. Discussion: As a sequela to this clinical presentation, our patient developed pulmonary hypertension. This report delves into the challenges and complexities involved in diagnosing and treating pulmonary hypertension, while also highlighting the unique presentation of this patient.

Takotsubo syndrome (TTS) is a rare cardiomyopathy, but its prevalence is increasing due to the greater availability of diagnostic tools, whose pathophysiology is unknown; however, the evidence points to an excess of catecholamines that ends up generating cardiac stunning. The cause of excessive sympathetic discharge is multifactorial, and some tumors may be related to their origin. In this case report, we present a female patient with TTS whose only identified triggering factor was an atrial myxoma, which generated an unusual clinical presentation. Current multimodal diagnostic tools together with the multidisciplinary evaluation of the HeartTeam allowed an accurate diagnosis and an adequate management of the clinical picture.

Cardiac myxomas are rare tumors with risks of cardiac outflow obstruction and embolic events. Surgical excision of the tumor at the earliest is the definitive treatment. We report the successful anesthetic management of a 65-year-old female patient with incidental left atrial myxoma for right proximal femur nailing. The patient was asymptomatic with no significant cardiac history. Since fracture reduction cannot be deferred for a prolonged period, the case was taken up under general anesthesia with invasive blood pressure monitoring. [ABSTRACT FROM AUTHOR]

Cortical lesions (CLs) detected with double inversion recovery (DIR) magnetic resonance imaging (MRI) are very helpful in differentiating multiple sclerosis (MS) from other neuroinflammatory diseases of the central nervous system (CNS), that is, neuromyelitis optica spectrum disorders (NMOSDs). Furthermore, CLs are closely related to motor and cognitive impairment. We report a case of a 48-year-old female MS patient who developed several CLs during anti-CD20 therapy. Some CLs disappeared during follow-up MRIs. In the suspicion of a treatment failure, the screening for the autologous hematopoietic stem cell transplant (AHSCT) was performed with the evidence of an atrial myxoma. In MS patients with new CLs, a comorbid ischemic pathology should be considered and carefully investigated. [ABSTRACT FROM AUTHOR]

Atrial myxoma (AM) is the most common primary cardiac tumor. Its clinical presentation can be highly heterogeneous and can be characterized by many constitutional manifestations and development of rheumatologic symptoms.We report the case of a patient presenting with a seronegative arthritis characterized by articular and enthesis involvement and purpuric cutaneous lesions that was refractory to conventional treatments and that was later diag- nosed with an AM as first cause of the manifestations. AM can present with different symptoms; among them, it is able to cause some rheumatological manifestation as it is able to secrete proinflammatory cytokines, as interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and interferon γ (IFN-γ). The present case is of particular interest as it presents an AM as the cause of an inflammatory arthropathy with articular and enthesis involvement. A paraneoplastic screening is always relevant in rheumatology, especially when encountering a refractory disease. [ABSTRACT FROM AUTHOR]

A previously healthy 57-year-old male patient presented to our emergency department for palpitations, dry cough, and non-exertional chest pain. He denied lipothymia or syncope. Blood pressure was 160/90 mmHg, heart rate 76 beats/min, body temperature 36.4°C, respiratory rate was 14 breaths/min, and oxygen saturation 96% on room air. Physical examination revealed symmetrical air entry without wheezing or crackles, and a classical diastolic "tumor plop", not accompanied by another significant murmur at cardiac auscultation. Laboratory tests were all in the normal range, including troponin T (9.1 ng/mL, normal value

The presentation of cardiac tumors is rare, and cardiac myxomas (CM) are the most common; it is estimated that they account for 70% of all primary benign cardiac tumors, and of these, more than 75% of myxomas originate in the left atrium. A 40-year-old woman presented with syncope reported by a witness, followed by bradyphrenia and hypoactivity, and a weight loss of 13 kg. On admission, she reported paresis in the hands and feet of the left half of the body, mild dysarthria, and decreased left facial mimicry. Brain MRI showed multiple foci of ischemic behavior, considering thromboembolic disease. Echocardiography revealed a mass with mobile images suggestive of myxoma as the primary option, with a high probability of tumor embolism. Given these findings, referral to cardiovascular surgery was requested due to an intracardiac mass with a very high embolic risk, where histopathological study confirmed that the mass corresponded to an atrial myxoma. The presence of intracardiac masses is rare, with a low overall prevalence. The prevalence of myxomas is 58.14% [95% CI = 51.95; 64.09%], concluding myxoma as the most common. The clinical triad it may generate consists of syncopal episodes, thromboembolisms, and constitutional symptoms. Imaging studies are the first-line approach for identification. [ABSTRACT FROM AUTHOR]

Incidental findings are common in medicine and often lead to diagnostic and management dilemmas. Myxomas the most prevalent benign tumors can be incidentally diagnosed in almost 20% of cases. Here, we are presenting a case where a patient's fate changed from spinal disease to cardiac disease. A 60-year-old female presented with excruciating low back pain and was diagnosed with degenerative lumbar spine disease, planned for laminectomy. She was referred to the cardiology opinion regarding perioperative cardiac risk. On echocardiography, a 6.2 cm2 sessile mass attached to the interatrial septum was found, and a probable diagnosis of sessile left atrial myxoma was made. The same was confirmed on cardiac computed tomography. The patient was operated on and had no complications. Histopathology confirmed atrial myxoma.

The most common primary cardiac tumors in adults are atrial myxomas, with adolescent-onset being uncommon. In this case report, a 15-year-old female was hospitalized with cerebrovascular embolism and later diagnosed with a left atrial myxoma. She had previously shown signs of distal vascular micro thrombosis, including recurring bilateral lower extremity rash, which are crucial for the early diagnosis and differential diagnosis of atrial mucinous neoplasm. We reviewed the various clinical symptoms and diagnostic approaches to identify left atrial mucinous neoplasm. This patient also had a combination of endocrinerelated diseases. We reviewed the diagnostic approach for the Carney Complex (CNC) and discussed the role of thyroid disease in diagnosing CNC. [ABSTRACT FROM AUTHOR]

The incidence of cancer patients with cardiac diseases requiring surgery is rising as the population ages, and early detection of cancer and the use of new therapies are increasing survival rates. Cardiac tumors, despite their rarity, are an integral part of the cardio-oncology practice and require diagnosis and treatment. In recent years, the incidence of cardiac tumors has risen due to advancements in multimodality imaging, which have become more accessible and widespread. The association between treated breast cancer and myxoma could be considered a mere coincidence, but a few documented cases exist. We report the case of a patient with a history of breast cancer who presented, upon followup, a left atrial cardiac mass on cardiovascular imaging and underwent immediate surgery. This case illustrates the importance of Cardio-Oncology Clinics during the follow-up of breast cancer survivors. [ABSTRACT FROM AUTHOR]

Myxomas are very rare intracardiac benign tumors. They can arise in any of the cardiac chambers, although 75% occur in the left atrium. Atrial myxomas (AMs) show a female predominance with a sex ratio of 3:1. There is a diversity in the clinical presentation; it may resemble many cardiovascular or systemic diseases. Furthermore, it is possible to present as an acute upper or lower limb ischemia or organ infarction due to systemic emboli. Hereby, we report a previously healthy 38-year-old male, who presented to the emergency department with acute pain of both lower limbs, unilateral upper limb, and acute abdomen. A bedside transthoracic echocardiogram was done which showed a mass that was confirmed to be an AM. The patient underwent surgical embolectomy and tumor resection. As this tumor is rare, the duration between the onset of symptoms to finally reaching the correct diagnosis is usually prolonged, and meanwhile, the patient can experience irreversible neurological damage or even death. Hence, we would like to highlight the role of echocardiogram in detecting AMs. In addition, excluding the primary cause of the thrombi, the patient’s ischemic pain has a spectrum of differential diagnosis ranging from peripheral vascular disease to COVID-19. We would also like to emphasize the importance of a high index of suspicion by emergency physicians when such cases present.

Generally, cardiac masses are initially suspected on routine echocardiography. Cardiac magnetic resonance (CMR) imaging is further performed to differentiate tumors from pseudo-tumors and to characterize the cardiac masses based on their appearance on T1/T2-weighted images, detection of perfusion and demonstration of gadolinium-based contrast agent uptake on early and late gadolinium enhancement images. Further evaluation of cardiac masses by CMR is critical because unnecessary surgery can be avoided by better tissue characterization. Different cardiac tissues have different T1 and T2 relaxation times, principally owing to different internal biochemical environments surrounding the protons. In CMR, the signal intensity from a particular tissue depends on its T1 and T2 relaxation times and its proton density. CMR uses this principle to differentiate between various tissue types by weighting images based on their T1 or T2 relaxation times. Generally, tumor cells are larger, edematous, and have associated inflammatory reactions. Higher free water content of the neoplastic cells and other changes in tissue composition lead to prolonged T1/T2 relaxation times and thus an inherent contrast between tumors and normal tissue exists. Overall, these biochemical changes create an environment where different cardiac masses produce different signal intensity on their T1- weighted and T2- weighted images that help to discriminate between them. In this review article, we have provided a detailed description of the core CMR imaging protocol for evaluation of cardiac masses. We have also discussed the basic features of benign cardiac tumors as well as the role of CMR in evaluation and further tissue characterization of these tumors.

ObjectiveTo use CiteSpace and VOSviewer visual metrology to analyze the research status, frontier hotspots, and trends in research on atrial myxoma.MethodsThe Web of Science core collection database was used to retrieve relevant literature on atrial myxoma from 2001 to 2022. CiteSpace software was used to analyze keywords with a co-occurrence network, co-polymerization class, and burst terms, and a corresponding visual atlas was drawn for analysis.ResultsA total of 893 valid articles were included. The country with the highest number of articles was the United States (n = 186). The organization with the highest number of articles was the Mayo Clinic (n = 15). The author with the highest number of articles was Yuan SM (n = 12). The highest cited author was Reynen K (n = 312). The highest cited journal was Annals of Thoracic Surgery (n = 1,067). The most frequently cited literature was published in the New England Journal of Medicine in 1995, which was cited 233 times. The keywords co-occurrence, copolymerization analysis, and Burst analysis revealed that the main research focuses were surgical methods, case reports, and genetic and molecular level studies on the pathogenesis of myxoma.ConclusionsThis bibliometric analysis revealed that the main research topics and hotspots in atrial myxoma included surgical methods, case reports, genetic and molecular studies.

This article discusses a rare case of atrial myxoma, a type of heart tumor, presenting as bilateral cerebellar infarct and mitral obstruction. The patient, a hypertensive septuagenarian, experienced acute dizziness and vomiting and was diagnosed with a stroke. Imaging tests revealed infarcts in both cerebellar hemispheres, and a cardiovascular examination identified a mass in the left atrium causing obstruction. The diagnosis was confirmed by cardiac MRI, and the patient is now awaiting myxoma excision. The article emphasizes the importance of routine cardiac evaluation in cases of ischemic stroke, especially when it is bilateral. [Extracted from the article]

Right heart thrombus (RHTh) with concurrent acute pulmonary embolism (PE) is rare and can seriously destabilize hemodynamics, leading to an emergency situation with high mortality. Diagnosis and treatment of RHTh with acute PE are not yet standardized. There are few reports of acute PE concurrent with RHTh and even less is known about patients with a right heart mural thrombus. For physicians, the diagnostic choice and treatment of these patients are particularly difficult due to the lack of knowledge. Here, we report a rare case of partial mural RHTh (type C RHTh) with acute PE. The mural mass in the right heart was initially diagnosed as atrial myxoma according to transthoracic echocardiography (TTE), and both pulmonary embolus and the mural mass were completely absorbed after administering Rivaroxiban. This case suggests that TTE alone is insufficient to identify and diagnoses a right heart mural mass such as this. However, novel oral anticoagulants may be effective at alleviating PE with type C RHTh. [ABSTRACT FROM AUTHOR]

Background: Cardiac tumors are rare, with a low incidence of between 0.0017 and 0.19%. The majority of cardiac tumors are benign and predominantly occur in females. The aim of our study was to examine how outcomes differ between men and women. Methods: From 2015 to 2022, 80 patients diagnosed with suspected myxoma were operated on. In all patients, preoperative, perioperative, and postoperative data were recorded. Such patients were identified and included in a retrospective analysis focused on gender-related differences. Results: Patients were predominantly female (n = 64; 80%). The mean age was 62.76 ± 13.42 years in female patients and 59.65 ± 15.84 years in male patients (p = 0.438). The body mass index (BMI) was comparable in both groups: between 27.36 ± 6.16 in male and 27.09 ± 5.75 (p = 0.945) in female patients. Logistic EuroSCORE (LogES) (female: 5.89 ± 4.6; male: 3.95 ± 3.06; p = 0.017) and EuroSCORE II (ES II) (female: 2.07 ± 2.1; male: 0.94 ± 0.45; p = 0.043), both scores to predict the mortality in cardiac surgery, were significantly higher in female patients. Two patients died early, within 30 days after surgery: one male and one female patient. Late mortality was defined as the 5-year survival rate, which was 94.8%, and 15-year survival rate, which was 85.3% in our cohort. Causes of death were not related to the primary tumor operation. The follow up showed that satisfaction with surgery and long-term outcome was high. Conclusion: Predominately female patients presented with left atrial tumors over a 17-year period. Relevant gender differences aside from that were not evident. Surgery could be performed with excellent early (within 30 days after surgery) and late results (follow up after discharge). [ABSTRACT FROM AUTHOR]

Atrial myxomas are primary cardiac tumors which may cause ischemic stroke. The authors present a case of a 51-year-old man admitted to the emergency department with right-sided hemiplegia and aphasia caused by ischemic stroke. 2D and 3D transesophageal echocardiography showed an atrial myxoma described as a large mass in the left atrium attached to the interatrial septum. In the end, surgical excision of the myxoma was performed 48 h after diagnosis. Nowadays, specific guidelines concerning the correct time for surgical excision of the myxoma are lacking. The authors highlight the utmost role of echocardiography to promptly characterize a cardiac mass and the importance of discuss about the timing of cardiac surgery. Atrial myxoma is a rare cardiac tumor that is often located in the left atrium of the heart. Patients with myxoma can have no symptoms, or they can present signs of systemic embolization, where fragments of the tumor have been released into the blood stream and are circulating to different areas of the body. Indeed, if a fragment reaches the brain, it can cause a cerebral acute ischemic stroke, which is a sudden loss of blood circulation to an area of the brain, resulting in a loss of neurologic function. Transesophageal echocardiography, an ultrasound test that produces real-time and detailed images of the heart, is a useful tool that allows physicians to diagnose the presence of an atrial myxoma. In this case report, the authors stress the role of echocardiography in diagnosing patients presenting with sudden neurological symptoms, because it can show a potential mass inside the heart. Once identified, the tumor can be removed surgically as soon as possible to avoid further complications, such as a new stroke. The authors describe a case of an ischemic stroke caused by a large atrial myxoma, which was surgically removed 48 h after diagnosis. [ABSTRACT FROM AUTHOR]

Background: The association between cerebral aneurysms and left atrial myxoma is known but rare. We described its pathogenesis, clinical presentation, diagnostic findings and treatment using a systemic review of the literature. Methods: MEDLINE via PubMed was searched for articles published until August 2022 using the keywords "atrial myxoma", "cardiac myxoma" and "cerebral aneurysm". Results: In this review, 55 patients with multiple myxomas aneurysms were analyzed, and 65% were women. The average age when aneurysms were diagnosed was 42.5 ± 15.81; most patients were less than 60 years old (86%). Aneurysms could be found before the diagnosis, at the same time as cardiac myxoma, or even 25 years after resection of the atrial mass. In our review, the mean time to diagnoses was 4.5 years. Our review estimates that the most common symptoms were vascular incidents (25%) and seizures (14.3%). In 15 cases, variable headaches were reported. Regarding management strategies, 57% cases were managed conservatively as the primary choice. Conclusions: Although cerebral aneurysms caused by atrial myxoma are rare, the long-term consequences can be serious and patients should be monitored. [ABSTRACT FROM AUTHOR]

A 38-year-old right-handed female with a past history of intermittent painful rash, dizzy spells, and chronic daily headaches as well as episodic migraines experienced an episode of transient involuntary pathological laughter, right arm weakness, and expressive dysphasia. She was found on MRI to have multiple strokes in multiple vascular distributions, including one in the head of the left caudate. A cardiac ECHO found an atrial myxoma, with extensive evaluation for other causes of stroke unrevealing. The differential diagnosis for pathological laughter in this patient is discussed. The most plausible cause in this patient is an infarct to the head of the left caudate nucleus caused by an embolus of the atrial myxoma.

Cardiac myxoma is a primary tumor histologically formed by multipotent subendocardial mesenchymal cells. Myxomas account for approximately 50% of all cardiac tumors in adults. Myxomas are most commonly located in the left atrium. Very rarely, myxomas can be located in several heart chambers. Only about 100 cases of patients with myxomatous lesions of both atria have been described in the literature. In this paper, we present a successful clinical case of a young patient with biatrial myxomas.

A 29-year-old woman (gravida 3, para 2) presented at 28 weeks+2 days of gestation with a two-months history of dyspnea associated with orthopnea and occasional palpitations. On transthoracic echocardiography, she was diagnosed with a 3.2 × 2.7 cm left atrial myxoma. The patient underwent open surgical resection at 30 weeks of gestation. She had an uneventful postoperative recovery and was discharged on the ninth day. At 41 weeks of gestation, she gave birth by cesarean to a healthy baby of normal weight. Both the mother and the baby were discharged in stable condition.

Abstract Cardiac myxomas are the most common primary cardiac tumors in adults, with the left atrium being the most frequently affected. Echocardiography is the diagnostic modality of choice. The most effective treatment for cardiac myxomas is surgical excision.