Giant Myxoma of the Left Atrium Simulating Mitral Stenosis

Mathhar Aldaoud, MD*1; Nikhil Mehta, MD1 and Amr Salama2, (1)Unity Health System, Rochester, NY, (2)unity hospital-rochester regional health, rochester, NY

Meeting: Hospital Medicine 2016, March 6-9, San Diego, Calif.

Abstract number: 410

Categories: Adult, Clinical Vignettes Abstracts

Case Presentation: A 36 year old female patient presented to the hospital with progressive shortness of breath for the last several months.

She denied chest pain, fever, or syncope. Her blood pressure was 133/77 mmHg with a pulse rate of 80 beats per minute, a respiratory rate of 18 breaths per minute, an oxygen saturation of 97 percent on a room air and a temperature of 36.7 degrees celsius. Cardiac auscultation revealed low pitched, Grade III/VI diastolic murmur that was best heard at the apex. Trace edema was present in the lower extremities.  

A complete blood count was unremarkable and her liver and kidney function were at baseline. The troponin I was normal and an electrocardiogram showed normal sinus rhythm with right axis deviation. The chest radiograph was unremarkable. A transthoracic echocardiography was notable for enlargement of both atria and a large mobile mass was revealed in the left atrium measuring 7 x 2.5 cm that appeared to be attached to the interatrial septum with a narrow stalk that extended into the left ventricle during diastole. Mild mitral and tricuspid regurgitation with mild estimated pulmonary artery hypertension was also noted. The systolic function was preserved with an estimated left ventricular ejection fraction of 55%. The patient was referred for open-heart surgery, which was performed with a cardio-pulmonary bypass. The mass was successfully excised and a histopathological examination showed typical features of Myxoma.

Discussion: Myxomas accounts for approximately 75% of primary cardiac neoplasms. Left atrial myxomas become symptomatic when they obstruct the mitral valve, embolize or cause systemic effects. Although more than half of left atrial myxoma’s show obstructive symptoms, it is only in 10% of patients that it will cause severe stenosis just like in our patient. The severity of obstruction is determined by the size, location and mobility of the myxoma.

Conclusions: Myxomas are benign histologically and have an excellent long-term prognosis with low recurrence rates after surgical resection. In summary, Myxomas should be considered in the differential diagnosis in patients with suspected mitral valvular disease.

To cite this abstract:

Aldaoud M, Mehta N, Salama A. Giant Myxoma of the Left Atrium Simulating Mitral Stenosis. Abstract published at Hospital Medicine 2016, March 6-9, San Diego, Calif. Abstract 410. Journal of Hospital Medicine. 2016; 11 (suppl 1). Accessed April 1, 2020.

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