Atrial thrombus masquerading as atrial myxoma: Preliminary analysis of echocardiographic findings

We retrospectively analyzed the echocardiographic findings of 8 patients with atrial thrombus (AT). This study was conducted in Yijishan Hospital between January 2019 and September 2021. Of the 8 patients, right atrial mass was detected in 4 patients, and left atrial mass was detected in the rest 4 patients. All masses were initially diagnosed as myxoma, which were later confirmed as thrombus. Athough echocardiography can provide significant information about the nature of atrial mass in many patients, a small percentage of atrial masses remain difficult to make a qualitative diagnosis.

Abstract 17116: Recurrent Atrial Myxomas As A Presenting Feature Of Carney Complex

Case Presentation: A 24-year-old man with a history of adrenal insufficiency on hydrocortisone presented to the hospital after losing consciousness in a swimming pool and was found to have an acute MCA stroke. PMHx was significant for left atrial myxoma status post resection 3 years ago, known L frontal brain, L adrenal, and testicular masses status post-resection. His father had a history of resected left atrial mass. Cardiology was consulted for a L atrial mass on the bedside echocardiogram upon initial emergency evaluation, during which the patient was placed on mechanical ventilation with stable vitals. The cardiovascular exam revealed a midsternal scar but was otherwise normal. Pulses were 2+ bilaterally on the upper and lower extremities. The skin was noted to have multiple hyperpigmented macules resembling cafe-au lait spots. The patient underwent mechanical thrombectomy with thrombolysis for his large MCA occlusion. His postoperative course was complicated by a worsening neuro exam in the setting of mid-line shift for which he had undergone decompressive hemicraniectomy. His adrenal insufficiency was managed by endocrinology. A TTE was significant for a L atrial mass measuring 4.8 cm attached to the interatrial septum with a stalk. A CT scan identified 2 discrete hypodensities of 8 mm and 3.8 cm which were thought to be the cardioembolic source for the stroke. An abdominal CT revealed a recurrent L adrenal neoplasm with absent R adrenal gland post resection of neoplasm. Conservative cardiac management was elected in the setting of a worsening neuroprognosis with follow-up post neurologic insult. Discussion: Considering the constellation of neoplastic and cutaneous findings, this was diagnosed as a case of Carney complex. This case identifies recurrent myxoma as a unique feature of Carney complex, ruling out other differentials such as neurofibromatosis and MEN syndrome. It highlights the importance of screening to prevent embolic stroke from recurrent myxomas.

Extramedullary intracardiac multiple myeloma misdiagnosed as a thrombus: a case report

Background Extramedullary intracardiac multiple myeloma (MM) is extremely rare. Patients with extramedullary intracardiac MM may suffer from a poor prognosis. Experience in the diagnosis and therapy of cardiac involvement in MM is limited. Herein, we describe a 67-year-old male with extramedullary intracardiac MM who was initially misdiagnosed with a thrombus. Case presentation A 67-year-old male was admitted for exertional dyspnea and fatigue. The patient was diagnosed with MM one year earlier and had complete remission after chemotherapy. He was implanted with a permanent pacemaker two months prior due to sick sinus syndrome. After this admission, transthoracic echocardiography (TTE) and computed tomography (CT) confirmed the existence of a large right atrial mass extending to the superior and inferior vena cava. We initially considered the right atrial mass as a thrombus and performed surgical treatment for the patient. The surgical intervention partially relieved the obstruction of the superior and inferior vena cava and improved hemodynamics. Postoperative pathological examination of the right atrial mass suggested malignant plasmacytoma associated with MM. After recovery from the surgery, the patient received one cycle of chemotherapy. A follow-up of seven months revealed that our patient was still alive with a good general condition. Conclusions Increasing the awareness of extramedullary intracardiac lesions in patients with MM is warranted. Our case confirmed that surgical intervention followed by adjuvant chemotherapy could improve the patient’s hemodynamics and achieve remission of cardiac symptoms.

A Case Report of primary cardiac intimal sarcoma presenting with atrial fibrillation and a Left Atrial Mass

Background Intimal sarcoma is an exceedingly rare type of primary cardiac tumour. It is characterized by poorly differentiated spindle-shaped cells that can mimic smooth muscle and is strongly associated with MDM2 genetic amplification. Owing to its rarity and nondistinctive histological features, diagnosis remains a significant challenge. Case Summary In this case report, we describe a case of primary cardiac intimal sarcoma in a 37-year-old woman who presented with atrial fibrillation and a left atrial mass. Despite having a histological sample from an excised left atrial mass, the diagnosis was not made until she presented with back pain secondary to metastatic disease to the spine. Discussion Primary cardiac intimal sarcoma is an extremely rare diagnosis. The mainstay management of intimal cardiac sarcoma is aggressive surgical resection. Unfortunately, the prognosis of cardiac sarcomas remains very poor, with a mean survival between three months to one year. This case of cardiac intimal sarcoma highlights the difficulty in establishing a diagnosis, particularly given the unusual presentation of atrial fibrillation.

Congenital Solitary Left Atrial Mass

Rhabdomyoma in the absence of tuberous sclerosis presenting as a large solitary atrial mass is an atypical finding. We hereby present images from an infant with a fetally diagnosed large left atrial mass with no evidence of mitral valve dysfunction who subsequently developed persistent arrhythmias requiring surgical resection of the mass in the neonatal period.