Cardiac Myxoma With Atypical Presentation Leading to Delayed Diagnosis: A Case Report

TL;DR

An 82-year-old man with atypical cardiac myxoma experienced multiple strokes due to delayed diagnosis, highlighting the need for advanced imaging in cryptogenic stroke cases.

Contribution

Highlights the diagnostic challenge of atypical cardiac myxoma morphology and its link to recurrent embolic stroke.

Findings

Atypical cardiac myxoma can mimic lipomatous hypertrophy of the interatrial septum.

Delayed diagnosis of cardiac myxoma can lead to multiple embolic strokes.

Advanced cardiac imaging is crucial for identifying atypical myxomas in cryptogenic stroke cases.

Abstract

Stroke is a major cause of death worldwide, with most cases being ischemic in presentation. Cardioembolic phenomenon contributes to a significant number of ischemic strokes. Cardiac myxomas, although generally benign, are the most common tumors arising in the left atrium. Left atrial tumors tend to grow into the atrial lumen and can cause symptoms similar to heart failure with mitral valve disease. Cardiac myxomas have typical pedunculated, gelatinous features and are at risk of microthrombi formation. However, when these typical features are not present, sessile cardiac myxomas can be mistaken for lipomatous hypertrophy of the interatrial septum. Embolic phenomenon from myxoma microthrombi can lead to serious neurological complications, which can be difficult to diagnose. We present a case of an 82-year-old male patient with multiple strokes and findings of left atrial myxoma with atypical features. This case illustrates the diagnostic challenge posed by atypical cardiac myxoma morphology leading to recurrent embolic stroke. Advanced cardiac imaging, beyond a transthoracic echocardiogram, may be warranted when evaluating cryptogenic stroke to rule out cardiac myxomas.

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