Left atrial mobile hydatid cyst mimicking left atrial myxoma and mitral stenosis and causing heart failure and arrhythmia

Cardiac hydatid cysts are very rare in hydatid cyst disease. We report herein a case of hydatid cyst mimicking left atrial myxoma. A 78-year-old woman was admitted to our hospital with complaint of dyspnea and signs pulmonary edema and mitral stenosis. Echocardiography showed left atrial mobile, mostly solid mass with wall calcifications moving towards the orifice of the mitral valve. We also found loculated giant hepatic and right pulmonary cysts. We aimed to report this case because of mimicking mitral stenosis and left atrial myxoma and causing heart failure.     

Pulmonary edema of an unexpected cause

Atrial myxoma is rarely seen in practice. We report a 67-year-old female who presented with acute cardiac insufficiency and pulmonary edema. Cardiac murmur was not detected on precordial examination. Urgent echocardiography, however, revealed atrial myxoma causing mitral valve obstruction. We point out that a normal cardiac examination does not exclude atrial myxoma. The diagnosis may be delayed until significant myocardial dysfunction occurs, as reported here. The clinical presentation of cardiac myxoma is discussed, along with appropriate investigations and treatment.     

Diagnostic and clinical features of atrial myxoma (author's transl)

The most common benign cardiac tumours are artial myxomas. Characteristically they may interfere with the normal functioning of atrioventricular valves or manifest themselves by embolism to cerebral or peripheral arteries or they may mimic systemic diseases. Hence, early diagnosis and immediate surgical treatment are important. A case of left atrial myxoma is reported and the various non-invasive and invasive diagnositc methods and their significance are outlined. If the angiocardiographic findings are questionable, the echocardiographic features are believed to be of greater reliability. Finally, the histopathology of atrial myxoma, the rate of tumour growth, as well as the possibility of postoperative reappearance of the myxoma are discussed.     

Thrombolysis and embolectomy in treatment of acute stroke as a bridge to open-heart resection of giant cardiac myxoma: A case report

BACKGROUNDCardiac embolism is a common cause of ischemic stroke in young adults. Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus. Early complete resection of giant cardiac myxoma is the key to its treatment and prevention of stroke recurrence.CASE SUMMARYA 42-year-old, previously healthy woman was admitted to the hospital with sudden-onset inability to speak and right-sided hemiplegia. While sweeping the floor 2 h prior to hospital admission, the patient developed sudden inability to express herself or understand what others were saying, accompanied by dyskinesia of the right limb, inability to walk or hold objects, and involuntary choreiform movements of the left upper limb. The patient was diagnosed with cerebral embolism and cardiac myxoma, complicated by left middle cerebral artery occlusion. The acute stroke was treated with intravenous thrombolytic therapy and arterial embolectomy as a bridging therapy to open resection of left atrial cardiac myxoma. The patient condition improved remarkably following initial thrombolysis and embolectomy and subsequently underwent emergency open resection of the atrial cardiac myxoma. She had no recurrence during 1-year follow-up.CONCLUSIONStrong consideration should be given to urgent intravenous thrombolysis (rt-PA, alteplase) in young adult stroke patients at the time of hospital admission. The present case demonstrated a highly successful outcome that combined thrombolysis and arterial embolus retrieval as a bridge to early complete resection of a giant cardiac myxoma for both stroke treatment and recurrence prevention.     

Left atrial mass caused by metastatic renal cell carcinoma: an unusual site of tumor involvement mimicking myxoma.

We report a case of a left atrial mass echocardiographically mimicking myxoma, in a patient with renal cell carcinoma. The mass was pathologically confirmed to be metastatic carcinoma, which had entered the left atrium from a mediastinal lymph node, via direct invasion of a pulmonary vein, illustrating the potential for unusual routes of tumor spread into the heart and the importance of obtaining a tissue diagnosis in such cases.     

Implantable Cardioverter Defibrillator Lead Endocarditis Causing Diffuse Right Atrial Abscess and Pulmonary Artery Embolism

Implantation of electrophysiological cardiac devices such as pacemakers and implantable cardioverter defibrillators has become a widely available and routine procedure in cardiovascular medicine. One of the most feared complications of device implementation is infection. Infection rates for these devices are reported to vary between 0.7% and 7.0%. Cardiac thromboembolic event is a recognized complication of permanent cardiac rhythm devices with an incidence of 0.6%–3.5%, unrelated to lead size or number. These complications are associated with high morbidity and mortality rates. In this case report, right atrial mass, right atrial abscess, perforation of tricuspid septal leaflet, and pulmonary embolism secondary to ICD lead endocarditis is presented. (PACE 2011; 34:e115–e117)     

An unusual case of giant cardiac fibroelastoma mimicking left atrial myxoma in a patient presenting with syncope

Cardiac papillary fibroelastomas are the most common primary valvular tumors. Generally benign, they account only for about 10% of all primary cardiac neoplasms, can occur in normal or diseased hearts, and are associated strongly with open heart surgery and radiotherapy. They are, in most cases, incidental findings, but can be discovered after syncope. We report the case of an elderly female, who was referred for syncope and was found to have a large fibroelastoma at the mitral valve annulus, intermittently obstructing the left ventricular inflow tract, and mimicking the presentation of left atrial myxoma. This case illustrates another potential mechanism of syncope in patients with fibroelastomas. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2013     

Cardiac Myxoma: A Rare Case Series of 3 Patients and a Literature Review

Myxoma is the most common tumor in the heart. A typical myxoma is relatively straightforward to diagnose. However, certain cardiac myxomas have rare features. We report three extremely rare cases of cardiac myxoma. One case involved a myxoma that originated from the annulus of the tricuspid after valvuloplasty, one case involved myxomas associated with left atrial thrombus and severe mitral stenosis, and the third case involved myxoma combined with severe calcification. All three cases were diagnosed by echocardiography and pathology. We also review clinical presentations and diagnostic characteristics of cardiac myxomas.     

Giant left atrial myxoma in an elderly patient: natural history over a 7-year period

We present the case of a 71-year-old woman with a 7-year history of a giant left atrial myxoma. The myxoma was attached to the atrial septum and occupied almost the entire left atrial cavity. The patient was hospitalized 4 times because of dyspnea on exertion, palpitations, fatigue, general asthenia, and weight loss. During prior hospitalizations, the patient had refused cardiac surgery. She developed several complications, including atrial fibrillation, mitral and tricuspid regurgitation, mesenteric embolism, pulmonary edema, and thrombotic stroke. We herein describe the natural history of left atrial myxoma in an elderly patient over a 7-year period.     

Venous thromboembolic disease presenting as inferior vena cava thrombus extending into the right atrium

With increasing use of echocardiography, especially transesophageal echocardiography, the diagnosis of intracardiac masses has surged. Masses that are most commonly seen in the atrial chambers include thrombi due to atrial fibrillation, cardiac myxomas often located in the atria, and valvular vegetations of infective endocarditis. In this report we present a case of a patient who developed thrombus in the inferior vena cava that extended up to the right atrium and presented as an apparent intracardiac mass. This mass embolized to the right pulmonary artery shortly after diagnosis resulting in pulmonary embolism, which the patient fortunately survived.     

Giant interatrial septal aneurysm mimicking a right atrial tumor

We report the case of a patient with a giant interatrial septum aneurysm who was admitted to our hospital for analysis of palpitations. Transthoracic echocardiography was not contributive and cardiac magnetic resonance imaging demonstrated a small interatrial septal aneurysm. In our study, only transesophageal echocardiography provided the correct diagnosis, showing a giant interatrial septal aneurysm protruding far away into the right atrium and mimicking a right atrial cystic tumor.     

Cardiopulmonary resuscitation may cause paradoxical embolism

This paper reports a case of paradoxical embolism of right heart thrombi visualized on transesophageal echocardiography during cardiopulmonary resuscitation (CPR). CPR may cause a right-to-left shunt by producing a sudden increase in right atrial pressure during the compression phase. In cardiac arrest patients with right heart thrombi who have received CPR, systemic embolization can occur owing to paradoxical embolism.     

心脏黏液瘤的外科治疗体会

目的 总结心脏黏液瘤的诊断及外科治疗体会.方法 回顾性分析山东大学齐鲁医院1990年1月至2007年5月收治的127例及厦门心脏中心近4年所收治的6例心脏黏液瘤患者临床资料.术前均经二维超声心动图明确诊断,其中肿瘤位于左心房109例、右心房22例、双心房2例.均在体外循环下取胸部正中切口,经右心房-房间隔途径摘除黏液瘤.同期行二尖瓣成形术11例,三尖瓣成形术6例.切除肿瘤均送检病理.结果 术后早期因严重低心排血量综合征死亡2例,术后新发脑栓塞6例,左下肢栓塞1例,肺栓塞1例.余患者术后未出现严重并发症,自觉症状较术前明显好转,心脏体征消失,痊愈.病理检查结果 均显示为心脏黏液瘤.结论 心脏黏液瘤多为良性,但引起的临床后果严重,一经诊断应尽早手术摘除;术中严防肿瘤脱落是手术成功的关键,且应注意术后随访;二维超声心动图是诊断心脏黏液瘤的最佳方法 .     

伴组织细胞样分化的心黏液瘤病理学观察

目的探讨伴有组织细胞样分化的心黏液瘤的病理学特点及鉴别诊断。方法报道1例伴有组织细胞样分化的心黏液瘤,进行组织学及免疫组化标记研究,并复习相关文献。结果患者男性,56岁。活动后呼吸困难伴心悸。超声发现右心房肿块。镜下肿瘤组织呈短条索状或实性巢样排列,大部分区域缺乏黏液样基质。肿瘤细胞呈组织细胞样,核圆形、卵圆形,染色质空泡状,有明显小核仁,缺乏核分裂。免疫组化:瘤细胞vimentin和calretinin(+),SMA、actin(sarcomeric)和S-100灶状(+),desmin、myoglobin、HMB45、melan-A、CDla、CD21、CD23、CD35、F、CD68、CD117、CK(AE1/AE3)、CK5/6、EMA、mesothelial和WT-1(-)。结论伴有组织细胞样分化的心黏液瘤为一种特殊类型,与经典型心黏液瘤相比具有独特的组织学特征,需与上皮样血管内皮瘤及炎性肌纤维母细胞瘤相鉴别。     

An atypical atrial flutter of focal origin: a study using a noncontact mapping system

We report a case of focal atrial tachycardia with appearance suggestive of atypical atrial flutter in a 57-year-old man. Based on ECG criteria, tachycardia was misclassified as atypical atrial flutter. The electrophysiological study using a noncontact mapping system revealed a focal activity within the left upper pulmonary vein ostium. This case highlights the limitations of standard electrocardiographic and electrophysiological classifications of regular atrial tachycardia. This report also shows the relevance of new mapping techniques in the successful mapping and ablation of these arrhythmias, even those arising within the left atrium.     

心房黏液瘤合并动脉栓塞的CT表现与临床治疗

目的 探讨心房黏液瘤合并动脉栓塞的CT表现、临床治疗及疗效。方法 收集6例左心房黏液瘤合并动脉栓塞患者,均于完善包括冠状动脉及外周动脉CTA检查在内的相关检查后行手术治疗;对其CTA表现及临床资料进行回顾性分析。结果 6例心房黏液瘤均发生于左心房,CT平扫呈低密度,3例动脉期强化,蒂宽窄不等,1例伴有钙化;6例均伴有动脉栓塞,栓塞部位为髂动脉2例、 肱动脉1例、 股动脉2例和腹主动脉伴两侧髂动脉多发栓塞1例。采用同期或分次心房黏液瘤切除联合外周动脉Fogarty导管取栓术进行治疗,无死亡病例,术后患者肢体疼痛消失。随访6个月~2年,均无心房黏液瘤复发或取栓部位黏液瘤再发种植转移,受累肢体血运良好。结论 CTA可对心房黏液瘤合并动脉栓塞作出较全面的诊断;采用心房黏液瘤切除辅以栓塞动脉Fogarty导管取栓术进行联合治疗可获得满意疗效。     

Multiperforated atrial septal “aneurysm in aneurysm”: Percutaneous closure guided by real‐time three‐dimensional transesophageal echocardiography

Atrial septal aneurysm (ASA) is a localized deformity of the interatrial septum, which protrudes into the right and/or left atrium. ASA with defects is a source of cardiac embolism. Although transcatheter closure is now a common procedure, it is still challenging in patients with complicated ASA. We describe a case of giant atypical multiperforated ASA with irregular mobility, which showed a rare “aneurysm in aneurysm” structure. Real‐time three‐dimensional transesophageal echocardiography showed vivid images, which clearly demonstrated these irregular shaped defects mimicking the atriotomy view, and played a crucial role in guiding the transcatheter closure.     

Acute pulmonary edema following carbon monoxide poisoning

This report describes a patient who presented with coma and acute pulmonary edema after severe carbon monoxide poisoning. Hemodynamic evaluation revealed elevated systemic and pulmonary arterial, pulmonary wedge and right atrial pressures, together with an increased cardiac output. These findings are compatible with the hypothesis that a neurogenic mechanism plays a role in the pulmonary edema of carbon monoxide poisoning.     

老年人心脏黏液瘤的临床特点与预后

目的探讨我国老年人心脏黏液瘤的临床特点、影像学特点及远期预后.方法收集1988年至2015年在解放军总医院住院手术的50例老年心脏黏液瘤患者病例资料,对其临床表现、影像学特点和远期预后进行回顾性分析.结果50例研究对象的平均年龄为（66.1±5.3）岁,其中女性16例.患者的病程平均为（15.7±21.7）年,临床症状表现为胸闷（20例）、心悸（20例）、呼吸困难（8例）、晕厥（8例）、脑栓塞（10例）、肢体栓塞（4例）、无力（14例）、发热（6例）、关节痛（4例）、无症状（6例）.X线胸片检查提示心脏肥大18例（36%）.超声心动图检查提示黏液瘤的好发位置依次为左心房44例（88%）、右心房2例（4%）,左房室瓣前叶1例（2%）,左心室1例（2%）.黏液瘤的平均体积为（33.04±13.81）cm^3.50例患者术后随访1-26年,平均（11.3±12.3）年,无复发及进展为恶性肿瘤者;2例患者死亡（4%）.术后栓塞相关危险因素为晕厥和无力,死亡相关危险因素为关节痛、无力和黏液瘤体积较大.结论老年心脏黏液瘤患者临床症状不典型,常见临床症状为胸闷和心悸,好发于左心房,远期死亡率和复发率均较低.     

Paradoxical embolism-report of a case involving four organ systems

Paradoxical embolism through a patent foramen ovale (PFO) can involve multiple organs simultaneously. The most commonly involved sites are the cerebrum and the extremities. Paradoxical embolism to coronary arteries or upper extremities is relatively uncommon. We report a case of acute pulmonary embolism and paradoxical embolism through a patent foramen ovale involving the left upper extremity, brain, and coronary artery. Early diagnosis in the emergency department was made by a trans-esophageal echocardiogram, and the patient was successfully treated with intravenous t-PA and heparin. Patients with acute pulmonary embolism or deep venous thrombosis who also develop signs of systemic embolism should be evaluated for a patent foramen ovale.