University of Central Florida College of Medicine, Graduate Medical Education, Orlando, FL, 32827, USA.
HCA Ocala Regional Medical Center, Internal Medicine Residency Program, 1431 SW 1st Ave, Ocala, FL, 34471, USA.
BMC Cardiovasc Disord. 2020 Mar 5;20(1):119. doi: 10.1186/s12872-020-01397-1.
A cardiac myxoma in a young person may pose a diagnostic challenge as symptoms may be variable and the differential diagnosis is wide. The differential diagnosis can include rheumatic mitral valve disease, pulmonary hypertension, endocarditis, myocarditis and vasculitis.
This case report involves a 49 years old female with a 2.8 cm × 3.4 cm myxoma in the left atrium causing mitral valve obstruction. She presented with fatigue, fever of unknown origin, transient ischemic attack and shortness of breath. Prompt surgery is often recommended due to the risk of embolic complications or complete obstruction. Due to her symptoms, patient underwent successful cardiothoracic surgery to excise the myxoma within 2 weeks of confirmation by cardiac echocardiography.
This case also emphasizes the diagnostic challenge as symptoms may be variable, ranging from fatigue, fever and shortness of breath to transient ischemic attack and at worst, sudden cardiac death. In conclusion, if a cardiac mass is suspected, echocardiography should be performed early. Surgical resection is curative and recurrence rate is very rare in sporadic isolated myxomas, however, recurrence can be higher in genetic diseases associated with increased frequency of myxomas such as Carney complex. This subpopulation of patients may present further research opportunity to learn more about the perioperative management of patients with myxomas such as determining the optimal time to surgical intervention and decision to anticoagulate.
年轻人的心脏黏液瘤可能会带来诊断上的挑战，因为症状可能多种多样，鉴别诊断范围很广。鉴别诊断包括风湿性二尖瓣疾病、肺动脉高压、心内膜炎、心肌炎和血管炎。
本病例报告涉及一名 49 岁女性，其左心房有一个 2.8cm×3.4cm 的黏液瘤，导致二尖瓣梗阻。她表现为疲劳、不明原因发热、短暂性脑缺血发作和呼吸困难。由于存在栓塞并发症或完全梗阻的风险，通常建议进行及时手术。由于患者的症状，在心脏超声心动图确诊后 2 周内，患者成功接受了心胸外科手术切除黏液瘤。
本病例还强调了诊断上的挑战，因为症状可能多种多样，从疲劳、发热和呼吸困难到短暂性脑缺血发作，甚至最坏的情况下，还会导致心源性猝死。总之，如果怀疑存在心内肿块，应尽早进行超声心动图检查。手术切除是治愈性的，散发性孤立性黏液瘤的复发率非常低，但与黏液瘤发生频率增加相关的遗传疾病（如卡尼综合征）的复发率可能更高。这些患者亚群可能为了解更多关于黏液瘤患者围手术期管理的知识提供进一步的研究机会，例如确定手术干预的最佳时机以及是否需要抗凝。
