ANSWER

Left atrial myxoma

• Myxoma is the most common primary cardiac tumor, 30-50%. Over 80% of myxoma occurs in the left atrium and 90% are solitary.
• Usual site of attachment is the atrial septum, in the area of fossa ovalis.
• Clinical presentation:

1. Cardiac: Due mechanical inteference of cardiac function such as mitral valve obstruction producing symptom and sign of mitral stenosis, particularly with body positional effect.

2. Embolization producing symptom and sign of systemic emboli, including neurologic emboli.

3. Synthesis and secretion of interleukin-6 (IL-6), an inflammatory cytokine producing symptom and sign similar to infection, autoimmune disease or collagen-vascular disease (ie. rheumatic disorder, systemic vasculitis, periarteritis nodosa).

It is possible that our case presentation is related to the #3 and/or #2.

 

(Please contact Drs teskey and Jokolvsky for more information on this case)

 

 

CURRENT REFERENCES

LEFT ATRIAL MYXOMA

Pinede L, Duhaut P, Loire R.
Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases.
Medicine (Baltimore). 2001 May;80(3):159-72. Review.

Reber D, Birnbaum DE.
Recurrent cardiac myxoma: why it occurs. A case report with literature review.
J Cardiovasc Surg (Torino). 2001 Jun;42(3):345-8. Review.

Amoah AG, Frimpong-Boateng K, Kallen C, Barwasser HM.
Atrial myxoma--a case report and review of the literature.
West Afr J Med. 1998 Jan-Mar;17(1):50-4. Review.

Lane GE, Kapples EJ, Thompson RC, Grinton SF, Finck SJ.
Quiescent left atrial myxoma.
Am Heart J. 1994 Jun;127(6):1629-31. Review. No abstract available.

Rey MJ, Tamm C, Faidutti B, Luthy P, Unger PF.
Growth rate of primary left atrial myxoma.
Eur Heart J. 1993 Aug;14(8):1146-7. Review. No abstract available.

Borden EC, Chin P.
Interleukin-6: a cytokine with potential diagnostic and therapeutic roles.
J Lab Clin Med. 1994 Jun;123(6):824-9. Review.

Jourdan M, Bataille R, Seguin J, Zhang XG, Chaptal PA, Klein B.
Constitutive production of interleukin-6 and immunologic features in cardiac myxomas.
Arthritis Rheum. 1990 Mar;33(3):398-402.

Feldman AR, Keeling JH 3rd.
Cutaneous manifestation of atrial myxoma.
J Am Acad Dermatol. 1989 Nov;21(5 Pt 2):1080-4. Review.

ECHOCARDIOGRAM

Alam M.
Pitfalls in the echocardiographic diagnosis of intracardiac and extracardiac masses.
Echocardiography. 1993 Mar;10(2):181-91. Review.

Vincelj J, Sutlic Z, Biocina B, Nikic N, Lajtman Z.
Diagnostic accuracy of transesophageal echocardiography for detection of atrial masses.
Acta Med Croatica. 2001;55(1):47-51.

Ha JW, Kang WC, Chung N, Chang BC, Rim SJ, Kwon JW, Jang Y, Shim WH, Cho SY, Kim SS, Cho SH.
Echocardiographic and morphologic characteristics of left atrial myxoma and their relation to systemic embolism.
Am J Cardiol. 1999 Jun 1;83(11):1579-82, A8.