An unusual cause of acute ischemic cardioembolic stroke in a middle aged lady: An incidentally detected large Left Atrial Myxoma – A Case Report.

Abstract

Abstract Introduction Primary cardiac tumors are rare but are surgically curable. Incidence of primary cardiac tumors varied between 0.0017% and 0.03 % in previous studies. Left atrial (LA) myxoma is the most common primary cardiac tumor, locally invading heart or lung tissue, causing left ventricular dysfunction, arrhythmia, pericardial effusion or cardiac tamponade. Again, tumor fragment breakdown or tumor thrombi can result in embolic manifestations, the most deadly manifestations being neurologic. Here we report an unusual cause of acute ischemic cardio-embolic stroke in a middle-aged lady, an incidentally detected large LA myxoma. Case presentation A 45-year-old hypertensive lady presented at the Emergency Department (ED) with acute onset aphasia, right facial droop, right sided hemiplegia and left sided subconjunctival haemorrhage. A large LA myxoma was incidentally detected through Transthoracic Echocardiography, which was the cause for the stroke. Excision of LA myxoma was done through a standard median sternotomy, under cardiopulmonary bypass, using the right atrial approach. Histopathology examination of the excised jelly-like mass confirmed it to be an LA myxoma. The patient has been doing well at a follow up period of six months. Conclusions Cardiac tumors are rare, but embolic complications can prove to be devastating, especially neurologic. A strong clinical suspicion followed by a thorough physical examination is mandatory as the history can often be misleading, with non-specific signs and symptoms. Trans-esophageal Echocardiography remains the gold standard for diagnosis. Once detected, the tumor needs to be excised at the earliest to prevent further complications.