Benko Jakub, Péč Martin Jozef, Cingel Marek, Jurica Jakub, Bolek Tomáš, Mokáň Marián, Samoš Matej
Department of Internal Medicine I, Jessenius Faculty of Medicine at Comenius University, Martin, Slovakia.
Department of Cardiology, Faculty Hospital, Nitra, Slovakia.
Eur J Case Rep Intern Med. 2024 Apr 3;11(5):004490. doi: 10.12890/2024_004490. eCollection 2024.
Myxoma of the left atrium is a less typical cause of mitral obstruction. If this develops, a flash pulmonary oedema can be the first manifestation.
We present a case report of a 50-year-old woman who was admitted to our internal department because of dyspnoea. The patient overcame a stroke three years before the index hospitalisation with a negative transthoracic echocardiography. By anamnesis and physical examination, an exacerbation of COPD was assumed, and the patient was treated accordingly. As the patient showed numerous risk factors for heart failure with preserved ejection fraction, transthoracic echocardiography was performed. A large polypoid mass was found in the left atrium, which caused severe mitral obstruction. Subsequent transoesophageal echocardiography confirmed this finding. The patient underwent urgent cardiac surgery, and the tumour was successfully resected. A histological examination revealed a cardiac myxoma. After the cardiac surgery the patient felt well, and no recurrence of the tumour occurred.
We provide a case report of a fast-growing myxoma that was incidentally found in a patient with dyspnoea. We highlight the fast growth rate of the tumour and the potential for misdiagnosed signs of pulmonary oedema caused by mitral obstruction.
Myxomas are the most common primary tumours of the heart, which can manifest a variety of symptoms such as fever, weight loss, thromboembolism, or mitral obstruction.The symptoms of acute exacerbation of COPD and cardiogenic pulmonary oedema can overlap and can be difficult to differentiate by anamnesis and physical examination alone.Transthoracic echocardiography has a high sensitivity for cardiac masses and is the examination of choice when these are suspected.
左心房黏液瘤是二尖瓣梗阻较少见的病因。若出现二尖瓣梗阻，突发肺水肿可能是其首发表现。
我们报告一例50岁女性因呼吸困难入住我院内科。该患者在本次住院前三年曾患中风，当时经胸超声心动图检查结果为阴性。通过问诊和体格检查，考虑慢性阻塞性肺疾病（COPD）急性加重，并对患者进行了相应治疗。由于该患者有多种射血分数保留的心力衰竭危险因素，遂行经胸超声心动图检查。结果发现左心房有一个巨大的息肉样肿块，导致严重的二尖瓣梗阻。随后经食管超声心动图检查证实了这一发现。患者接受了紧急心脏手术，肿瘤被成功切除。组织学检查显示为心脏黏液瘤。心脏手术后患者恢复良好，肿瘤未复发。
我们报告了一例在呼吸困难患者中偶然发现的快速生长的黏液瘤病例。我们强调了肿瘤的快速生长速度以及二尖瓣梗阻导致肺水肿体征被误诊的可能性。
黏液瘤是最常见的原发性心脏肿瘤，可表现出多种症状，如发热、体重减轻、血栓栓塞或二尖瓣梗阻。COPD急性加重和心源性肺水肿的症状可能重叠，仅通过问诊和体格检查难以鉴别。经胸超声心动图对心脏肿块具有较高的敏感性，是怀疑有心脏肿块时的首选检查方法。
