Hrev_master


Cardiac myxoma is the most common benign cardiac tumor
and one of the most frequent onset symptoms are neurological.1

A 54-year-old male suffering of hyperthension and dislipi-
demia was admitted by ambulance to the emergency department
after an acute neurological attack (aphasia, left gaze deviation,
anisocoria, diaphoresis). Due to clinical worsening up to GCS 4, he
was intubated and mechanically ventilated.

A head CT-scan (Figure 1) was negative for cerebral hemor-
rhage and brain tumors, a neck ultrasound scan showed no carotid
stenosis or dissection of the neck vessels. In the suspection of cere-
bral ischemia, systemic trombolysis was started. Due to technical
problems, angio CT-scan (Figure 2) was performed 1 hour later
and a sphenoidal segment (M1) left middle cerebral stenosis was
found; accidentally an atrial disomogeneous mass was discovered
(Figure 3). No intra-aortic trombolysis or tromboaspiration was
performed by interventional radiologist summoned at the end of
alteplase infusion. No indication for craniothomy wase made by
neurosurgeons.

Transesophageal echocardiography (Figure 4) confirmed a
large, peduncolated disomogeneous mass occuping the entire left
atrium, with extremities reaching the mitral valve plane, with signs
of obstruction. He was electively scheduled for resection 4 weeks
after the start of symptoms, when the risk of a catastrophic neuro-
logic event from anticoagulation during cardiopulmonary bypass
(due to the potential for hemorrhagic conversion) was considered
to be reduced.2,3 The patient was discharged on 35th day and he has
a good recovery.

                                                        Emergency Care Journal 2018; volume 14:7815

Correspodence: Rosanna Varutti, Department of Anaesthesia and
Intensive Care, AAS5 Friuli Occidentale, via Montereale, Pordenone,
Italy.
E-mail: rosanna.varutti@gmail.com

Key words: Embolic stroke; Atrial myxoma; Cardiac bypass.

Contributions: the authors contributed equally.

Conflict of interest: the authors declare no potential conflict of interest.

Funding: none.

Received for publication: 9 September 2018.
Revision received: 29 October 2018
Accepted for publication: 30 October 2018.

This work is licensed under a Creative Commons Attribution 4.0
License (by-nc 4.0).

©Copyright R. Varutti et al., 2018
Licensee PAGEPress, Italy
Emergency Care Journal 2018; 14:7815
doi:10.4081/ecj.2018.7815

A case of embolic stroke from atrial myxoma
Rosanna Varutti,1 Giulio Trillò,2 Rita Piazza,3 Flavio Bassi2

1Department of Anaesthesia and Intensive Care, AAS5 Friuli Occidentale, Pordenone; 2Department of
Anaesthesia and Intensive Care, ASUIUD, Udine; 3Department of Cardiology, AAS5 Friuli Occidentale,
Pordenone, Italy

Figure 1. Head CT scan showing a M1 left middle cerebral steno-
sis. The arrow indicates the stop of blood flow into the left mid-
dle cerebral artery.

Figure 2. Angio CT scan show-
ing a M1 left middle cerebral
stenosis (frontal and posterior
Willis circle view). The arrow
indicates the stop of blood flow
into the left middle cerebral
artery.

                                                                       [Emergency Care Journal 2018; 14:7815]                                                    [page 131]



[page 132]                                                     [Emergency Care Journal 2018; 14:7815]

References
1. Wen XY, Chen YM, Yu LL, et al. Neurological manifestations

of atrial myxoma: a retrospective analysis. Oncol Lett
2018;16:4635-9.

2. Thyagarajan B, kumar MP, Patel S, Agrawal A. Extracardiac
manifestations of atrial myxomas. J Saudi Heart Assoc
2017:29:37-43.

3. Hirose H, Youdelman BA, Entwistle JWC. Stroke from a large
left atrial myxoma. Open Cardiovasc Med J 2008;2:115-7.

                             Images in Emergency

Figure 3. Cardiac CT scan showing a disomogeneous atrial mass.
LV, left ventricle. The asterisk (*) indicates myxoma.

Figure 4. Transesophageal ecocardography, showing a peduncolate disomogeneous mass occuping the entire left atrium, with the
extremities until the mitral valve plane (on dyastolic and systolic left atrium contraction). RV, right ventricle; LV, left ventricle.