Transient Hemiparesis Caused by a Left Atrial Myxoma in a Child

Abstract

A previously healthy 4-year-old girl developed symptoms of an upper respiratory tract infection with fever; she was evaluated by her pediatrician on the fifth day of the illness and antibiotics were started because of concern of pneumonia. Although she had transient improvement, she presented to a local emergency department on day 7 of the illness after she developed sudden onset of left facial droop and a limp while playing hide-and-seek with her grandfather. She was subsequently transferred to our institution where her examination was significant for lethargy, right-sided weakness with facial droop, and an unusual low-pitched middiastolic clunk or “tumor plop.” Electrocardiography demonstrated frequent premature ventricular contractions, especially when lying on her left side, and echocardiography demonstrated a large left atrial mass (Figure, A) that unfolded with long villi into the left ventricle during diastole (Figure, B). Computed tomography and magnetic resonance imaging of the brain failed to demonstrate evidence of an acute infarct. She then underwent emergency surgical resection of a large 8-cm myxomatous tumor that was adherent to the left atrial septum (Figure, C). Pathology demonstrated a villous myxoma. Blood and urine cultures produced negative results. Her postoperative course was uneventful and she was symptom-free for 1 year with repeated echocardiography; Holter monitor and electrocardiography were normal without evidence of recurrent arrhythmia.