Giant Left Atrial Myxoma Masquerading as Cough-Syncope Syndrome.

Jennifer N Bowman,Kailash Bajaj,Pradnya Brijmohan Bhattad,Jennifer M Treece,Melania Bochis

doi:10.1177/2324709617724177

Abstract

Left atrial myxomas are the most common type of benign primary cardiac tumor. Patients can present with generalized symptoms, such as fatigue, symptoms from obstruction of the myxoma, or even embolization of the myxoma causing distal thrombosis. We describe a case with several-month duration of syncopal episodes that occurred after coughing and with exertion. Computed tomography of the chest showed a 6.1 cm by 4.5 cm mass in the left atrium, later evaluated with an echocardiogram. Cardiothoracic surgery removed the mass, and it was determined to be an atrial myxoma. It is important for an internist to be able to diagnose an atrial myxoma because of the risks associated with embolization and even sudden death as myxoma can block blood supply from atrium to ventricle.

Highlights

A 46-year-old male presented to the emergency department with several-month duration of exertional dyspnea after taking only a few steps with subsequent nonproductive coughing episodes leading to syncopal events
A cardiac tumor may be visualized on computed tomography (CT) scan of the chest, but it is difficult to differentiate a cardiac mass versus thrombus
An echocardiogram provides information about the mass including whether it obstructs circulation

Summary

Introduction

A 46-year-old male presented to the emergency department with several-month duration of exertional dyspnea after taking only a few steps with subsequent nonproductive coughing episodes leading to syncopal events. The patient had 2-month duration of bilateral lower extremity edema, abdominal distension, and generalized fatigue with diagnoses of portal venous thrombosis at the same time, with anticoagulation noncompliance. On presentation during this admission, the patient’s vital signs were within normal limits, and the patient was afebrile and had an oxygen saturation of 97% on room air. Preoperative findings included the left atrial mass, which appeared to be attached to the interatrial septum, biatrial enlargement, and a severely dilated and hypokinetic right ventricle.

Results

Discussion

Conclusion