Johari Muhamad Izzad, Ismail Mohd Noor, Mohamad Fadhilah, Yusof Mohd Aizuddin
General Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia.
General Medicine, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
BMJ Case Rep. 2021 Jan 18;14(1):e236420. doi: 10.1136/bcr-2020-236420.
Primary cardiac valve tumours are rare. This is a case report of a 32-year-old non-smoker man with a history of stroke 1 year prior and no other cardiovascular risk factors. The patient was admitted to our acute stroke ward for recurrent left hemiparesis, slurring of speech, facial asymmetry and central retinal artery occlusion. Initial laboratory investigations and ECG were normal. An urgent CT brain showed a large hypodense area at the right frontal, parietal, temporal, occipital region with effaced sulci and right lateral ventricle with midline shift and cerebral oedema in keeping with acute infarction. We proceeded with CT angiography of the cerebral and carotid on the following day, which revealed no evidence of thrombosis, aneurysm or arteriovenous malformation. There were no abnormal beaded vessels to suggest vasculitis. Transthoracic echocardiography revealed a large mobile mass in the left atrium. Meanwhile, MRI cardiac confirmed a large ill-defined mobile solid mass attached to the mitral valve's inferoseptal component suggestive of mitral valve myxoma. This case report highlights the significance of considering a cardiogenic source of emboli in patients with large cerebral infarcts and other cardiac embolic phenomena. Imaging modalities such as echocardiography and cardiac MRI will help detect treatable conditions, such as valvular myxoma and prevent further complications.
原发性心脏瓣膜肿瘤较为罕见。本文报告一例32岁男性,不吸烟,有1年前卒中病史,无其他心血管危险因素。该患者因反复左侧偏瘫、言语不清、面部不对称及视网膜中央动脉阻塞入住我院急性卒中病房。初始实验室检查及心电图均正常。急诊头颅CT显示右侧额、顶、颞、枕叶大片低密度区,脑沟消失,右侧脑室受压,中线移位及脑水肿,符合急性梗死表现。次日我们进行了脑部及颈动脉CT血管造影,未发现血栓形成、动脉瘤或动静脉畸形的证据。也未见异常串珠样血管提示血管炎。经胸超声心动图显示左心房有一巨大活动肿物。同时,心脏MRI证实二尖瓣下间隔成分附着有一巨大边界不清的活动实性肿物,提示二尖瓣黏液瘤。本病例报告强调了在患有大面积脑梗死及其他心脏栓塞现象的患者中考虑心源性栓子来源的重要性。超声心动图和心脏MRI等影像学检查有助于发现可治疗的情况,如瓣膜黏液瘤,并预防进一步并发症。