Signs and Symptoms of Chest Diseases: Student/Resident Case Report Poster - Signs and Symptoms of Chest Disease |

Atrial Myxoma Presenting as Intermittent Pulmonary Edema FREE TO VIEW

Sok Boon Tay, MMed; Kay See, MPH
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National University Health System, Singapore, Singapore

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1250A. doi:10.1016/j.chest.2016.08.1363
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SESSION TITLE: Student/Resident Case Report Poster - Signs and Symptoms of Chest Disease

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary cardiac tumors are rare. The clinical presentation depends on the location and size of the tumor and can range from an asymptomatic mass to a life-threatening intracardiac obstruction. We report a patient who presented with episodic pulmonary edema secondary to intermittent ventricular inflow tract obstruction from a large atrial myxoma.

CASE PRESENTATION: An 87 year old Chinese lady presented to us with acute shortness of breath while walking. She was known to have hypertension and hypothyroidism. She did not have chest pain. There were no preceding infective symptoms or symptoms of heart failure, apart from chronic leg swelling that worsened towards the evening. On auscultation, heart sounds were dual without murmurs and there were bibasal fine crepitations in the lungs. Left calf circumference was larger than right, with bilateral varicose veins and pitting edema. She initially required 3 litres of supplemental oxygen via nasal prongs, which was weaned off within hours without diuresis. A similar episode of acute breathlessness, desaturation and quick weaning of oxygen occurred again in the ward. Chest radiography showed perihilar congestion and small pleural effusions. D dimer was >4ug/mL. A computed tomography pulmonary angiogram (CTPA) was done to rule out pulmonary embolism. CTPA showed a 4.9 x2.3 cm filling defect in the left atrium extending into the left ventricle with left atrial enlargement and pulmonary vessel congestion (Fig. 1). An urgent transthoracic echocardiogram (TTE) confirmed a mobile mass in the left atrium attached to the interatrial septum that moved across the mitral valve, causing ventricular inflow obstruction (Fig. 2). Urgent cardiothoracic opinion was sought. The patient successfully underwent excision of the left atrial mass and a coronary artery bypass graft. Histology of the 5 x 3 x 1.5 cm pedunculated mass confirmed the diagnosis of cardiac myxoma.

DISCUSSION: The incidence of primary cardiac tumors is about 0.02%1. 80% are benign, of which half are myxomas2. Although benign, atrial myxomas are potentially lethal because of their location. Incomplete obstruction of the valve opening can result in pulmonary edema. Repeated motion of the tumor through the valve may also result in valve damage with chordal rupture. Temporary complete obstruction can result in syncope or sudden cardiac death. Growth of atrial myxomas has been postulated to be fast, at a rate of 0.49cm/month3. Our patient had a normal TTE just 3 years prior. Hence, prompt detection and early resection is potentially life-saving.

CONCLUSIONS: It is important to consider intracardiac lesions as a differential for intermittent pulmonary edema.

Reference #1: Reynen K. Frequency of primary tumors of the heart. Am J Cardiol. 1996 Jan 1;77(1):107.

Reference #2: Griffiths GC. A Review of Primary Tumors of the Heart. Prog Cardiovasc Dis. 1965 Mar;7:465-79.

Reference #3: Walpot J, Shivalkar B, Rodrigus I et al. Atrial myxomas grow faster than we think. Echocardiography. 2010 Nov;27(10):E128-31.

DISCLOSURE: The following authors have nothing to disclose: Sok Boon Tay, Kay See

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