Babs Animashaun Islamiyat, Akinseye Oluwaseun A, Akinseye Leah I, Akinboboye Olakunle O
Department of Internal Medicine, Harlem Hospital Center, New York, NY, USA.
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, NY, USA.
Am J Case Rep. 2015 Sep 21;16:645-7. doi: 10.12659/AJCR.894513.
Right atrial myxoma accounts for 15-20% of cardiac myxomas and syncope is a very rare manifestation. We present the case of an 89-year-old man with right atrial myxoma and syncope, and discuss the role of cardiac magnetic resonance imaging (MRI) in the diagnosis of myxomas.
An 89-year-old man with a history of hypertension, hyperlipidemia, chronic kidney disease stage 4, mild dementia, and benign prostatic hyperplasia presented to the emergency department with an episode of syncope. Physical examination demonstrated normal and regular heart sounds, and normal respiratory rate and oxygen saturation. Echocardiogram described a well-circumscribed echo-dense mass in the right atrial cavity, which was attached to the septum but not obstructing the tricuspid annulus, measuring 1.7×2.2 cm at its widest diameter. Cardiac MRI revealed a mass with dark intensity which enhanced heterogeneously following intravenous administration of gadolinium-chelate, consistent with a myxoma. The location of this myxoma, coupled with the presence of a stalk allowing mobility, provides a clue to how this patient experienced transient obstruction of the tricuspid valve leading to syncope.
Right heart tumors should be considered in the differential diagnosis of unexplained syncope. Cardiac MRI with gadolinium-chelate administration can help differentiate this tumor from a right-sided atrial thrombus, which can pose a diagnostic challenge.
右心房黏液瘤占心脏黏液瘤的15% - 20%，晕厥是一种非常罕见的表现。我们报告一例89岁患有右心房黏液瘤并伴有晕厥的男性病例，并讨论心脏磁共振成像（MRI）在黏液瘤诊断中的作用。
一名89岁男性，有高血压、高脂血症、慢性肾脏病4期、轻度痴呆和良性前列腺增生病史，因一次晕厥发作就诊于急诊科。体格检查显示心音正常且规律，呼吸频率和血氧饱和度正常。超声心动图描述右心房腔内有一个边界清晰的回声密集肿块，附着于房间隔但未阻塞三尖瓣环，最大直径为1.7×2.2厘米。心脏MRI显示一个在注射钆螯合物后强化不均匀的低信号肿块，符合黏液瘤表现。该黏液瘤的位置，加上有一个可活动的蒂，为该患者如何经历三尖瓣短暂梗阻导致晕厥提供了线索。
在不明原因晕厥的鉴别诊断中应考虑右心肿瘤。注射钆螯合物的心脏MRI有助于将这种肿瘤与右侧心房血栓区分开来，后者可能带来诊断挑战。
