IMAGING IN CARDIOLOGY
Left atrial myxoma as a cause of stroke
H.M.M. Al Hashimi, AJ. Wardeh, P.M.J. Verhorst, A.J.J. van Es, G.P. Molhoek
Figure 1. Left atrial m (Mx) protruding tbrougb the mitral valve during diastok. A. Apical view B. Parastenal long-axis view. LA.left atrium, LV=keft ventrick, RA=nht atrium, R V=rgbt ventricle, Ao=aorta.
A50-year-old female patient was admitted with a
A bilateral monocular diplopia. Past medical history
was unremarkable. Her physical examination was, besides the diplopia, normal. Laboratory tests showed
H.M.M. Al Hashimi A.J. Wardsh Department of Cardiology, Radboud University Medical Centre, NUrmegen, the Netherlands P.MJ. Verhorst A.J.J. van Es G.P. Molhoek Department of Cardiology, Twente Medical Centre, Enschede, the Netherlands
Correspondence to: H.M.M. Al Hashimi Department of Cardiology, Radboud University Medical Centre, P0 Box 9101, 6500 HB Nijmegen, the Netherlands E-mail: [email protected]
Netherlands Heart Journal, Volume 14, Number 7/8, August 2006
a mild anaemia with a slightly elevated erythrocyte sedimentation rate. ECG and chest X-ray were normal. Carotid Doppler showed no significant stenosis. MRI of the brain showed multiple bilateral occipital infarctions. Subsequently, an echocardiogram was performed, revealing a large left atrial myxoma attached to the atrial-septal wall and protruding into the left ventricle during diastole. There was no evidence of mitral valve regurgitation (figures LA and 1B). The left atrial myxoma, the cause of the stroke, was surgically removed with success. There were no complications in follow-up and the patient is doing well.
Discussion Primary cardiac tumours are rare, occurring with a frequency of 0.001 to 0.28% in postmortem series.' Atrial myxomas are the most common, constituting nearly 50% ofthe histologically benign tumours.IAtrial 265
IMAGING IN CARDIOLOGY
myxomas are generally found in the left atrium (75%) and are usually attached to the inter-atrial septum by a stalk. Patients suffering from a cardiac myxoma may present with symptoms due to cardiac flow obstruction, In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one page at the most) to Bohn Stafleu van Loghum, PO Box 246, 3990 GA Houten, e-mail: [email protected].
Thissection is edited byM.J.M. Cramer andjj. Bax.
266
constitutional symptoms, or embolic complications. Treatment is the surgical removal of the atrial myxoma. Atrial myxomas are a rare cause of stroke, accounting for less than 1% of all ischaemic strokes.2 Although rare, they should be considered in the differential diagnosis of any young adult who presents with an ischaemic stroke. U References 1 2
Neoplastic heart disease. In Alexander RW, Schlant RC, Fuster V, et al. Hurst's The Heart. 9th ed. New York: The McGraw-Hill Companies 1998:2295-318. Knepper LE, Biller J, Adams HP, et al. Neurologic manifestations of atrial myxoma: a 12 year experience and review. Stroke 1988;19: 1435-40.
Netherlands Heart Journal, Volume 14, Number 7/8, August 2006
pC
Left atrial myxoma as a cause of stroke
H.M.M. Al Hashimi, AJ. Wardeh, P.M.J. Verhorst, A.J.J. van Es, G.P. Molhoek
Figure 1. Left atrial m (Mx) protruding tbrougb the mitral valve during diastok. A. Apical view B. Parastenal long-axis view. LA.left atrium, LV=keft ventrick, RA=nht atrium, R V=rgbt ventricle, Ao=aorta.
A50-year-old female patient was admitted with a
A bilateral monocular diplopia. Past medical history
was unremarkable. Her physical examination was, besides the diplopia, normal. Laboratory tests showed
H.M.M. Al Hashimi A.J. Wardsh Department of Cardiology, Radboud University Medical Centre, NUrmegen, the Netherlands P.MJ. Verhorst A.J.J. van Es G.P. Molhoek Department of Cardiology, Twente Medical Centre, Enschede, the Netherlands
Correspondence to: H.M.M. Al Hashimi Department of Cardiology, Radboud University Medical Centre, P0 Box 9101, 6500 HB Nijmegen, the Netherlands E-mail: [email protected]
Netherlands Heart Journal, Volume 14, Number 7/8, August 2006
a mild anaemia with a slightly elevated erythrocyte sedimentation rate. ECG and chest X-ray were normal. Carotid Doppler showed no significant stenosis. MRI of the brain showed multiple bilateral occipital infarctions. Subsequently, an echocardiogram was performed, revealing a large left atrial myxoma attached to the atrial-septal wall and protruding into the left ventricle during diastole. There was no evidence of mitral valve regurgitation (figures LA and 1B). The left atrial myxoma, the cause of the stroke, was surgically removed with success. There were no complications in follow-up and the patient is doing well.
Discussion Primary cardiac tumours are rare, occurring with a frequency of 0.001 to 0.28% in postmortem series.' Atrial myxomas are the most common, constituting nearly 50% ofthe histologically benign tumours.IAtrial 265
IMAGING IN CARDIOLOGY
myxomas are generally found in the left atrium (75%) and are usually attached to the inter-atrial septum by a stalk. Patients suffering from a cardiac myxoma may present with symptoms due to cardiac flow obstruction, In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one page at the most) to Bohn Stafleu van Loghum, PO Box 246, 3990 GA Houten, e-mail: [email protected].
Thissection is edited byM.J.M. Cramer andjj. Bax.
266
constitutional symptoms, or embolic complications. Treatment is the surgical removal of the atrial myxoma. Atrial myxomas are a rare cause of stroke, accounting for less than 1% of all ischaemic strokes.2 Although rare, they should be considered in the differential diagnosis of any young adult who presents with an ischaemic stroke. U References 1 2
Neoplastic heart disease. In Alexander RW, Schlant RC, Fuster V, et al. Hurst's The Heart. 9th ed. New York: The McGraw-Hill Companies 1998:2295-318. Knepper LE, Biller J, Adams HP, et al. Neurologic manifestations of atrial myxoma: a 12 year experience and review. Stroke 1988;19: 1435-40.
Netherlands Heart Journal, Volume 14, Number 7/8, August 2006
pC
