Right Atrial Myxoma and Chronic Transudative Ascites: A Rare and Challenging Clinical Presentation

Abstract

Atrial myxomas are the most common primary cardiac tumors and account for about 40% to 50% of such masses.1 Right atrial (RA) myxomas account for about 25% of cardiac myxomas2 and are often difficult to diagnose. They may remain asymptomatic; however, patients will eventually develop nonspecific constitutional symptoms such as fever, weight loss, arthralgia, anemia, and clotting disturbances due to the production of interleukin-6.3 Embolic complications, syncope, and sudden death have also been reported.4 Although tumor fragmentation and embolization are more common in left-sided myxomas,5 rarely pulmonary embolization and secondary pulmonary hypertension may occur in patients with RA myxomas as well.6, 7 In addition, right ventricular failure and ascites may occur as a result of tricuspid valve orifice obstruction.8 Massive ascites is a highly uncommon extracardiac presentation of RA myxoma and may lead to an extensive clinical, paraclinical, and imaging investigation. Herein, we report such an unusual patient with a very large RA myxoma alongside chronic, persistent, and recurrent transudative ascites despite repeated peritoneocentesis.