Jaczyński Jakub, Kukla Piotr, Lichota Wojciech
Department of Vascular Surgery, Regional Specialist Hospital named after Dr. Wł. Bieganski in Grudziądz, Poland.
Department of Vascular Surgery, Regional Specialist Hospital named after Dr. Wł. Bieganski in Grudziądz, Poland.
Int J Surg Case Rep. 2025 Sep 8;136:111884. doi: 10.1016/j.ijscr.2025.111884.
Primary cardiac tumors are rare with myxomas representing about 50 % of benign types, typically arising sporadically in adults aged 30-60 and predominantly in the left atrium. Symptoms result from obstruction, embolization or arrhythmias. Embolic complications, particularly in young patients without cardiovascular risk factors, should raise suspicion of an intracardiac tumor. Prompt recognition and management are critical to prevent serious outcomes.
A 24-year-old woman presented with sudden bilateral lower limb paralysis and ischemic pain. Clinical evaluation revealed absent pulses and sensory-motor deficits in both legs. CTA demonstrated thrombotic occlusion at the aortic bifurcation and major arteries of both lower limbs, as well as signs of renal and splenic ischemia. Emergency embolectomy was performed using a Fogarty catheter and histopathology of embolic material revealed a cardiac myxoma. On postoperative day 0, reperfusion syndrome developed in the right leg necessitating fasciotomy. Echocardiography identified a left atrial mass which was surgically excised. The patient recovered with residual right peroneal nerve palsy and was referred for rehabilitation.
In young patients with embolic events and no prior cardiac disease, intracardiac tumors must be considered. Echocardiography is the diagnostic modality of choice, supported by CT/MRI when needed. Surgical resection is curative, but complications such as reperfusion syndrome can arise. Long-term follow-up with annual echocardiography is recommended due to recurrence risk.
This case illustrates the importance of early diagnosis, multidisciplinary intervention and coordinated care in achieving favorable outcomes in patients with cardiac myxoma presenting with acute embolic events.
原发性心脏肿瘤较为罕见，黏液瘤约占良性类型的50%，通常散发性地发生于30至60岁的成年人，且主要位于左心房。症状由梗阻、栓塞或心律失常引起。栓塞并发症，尤其是在无心血管危险因素的年轻患者中，应引起对心脏内肿瘤的怀疑。及时识别和处理对于预防严重后果至关重要。
一名24岁女性出现突发双侧下肢瘫痪和缺血性疼痛。临床评估显示双下肢脉搏消失及感觉运动障碍。CT血管造影显示主动脉分叉处及双下肢主要动脉血栓形成闭塞，以及肾和脾缺血迹象。使用Fogarty导管进行了急诊栓子切除术，栓子材料的组织病理学检查显示为心脏黏液瘤。术后第0天，右下肢出现再灌注综合征，需要进行筋膜切开术。超声心动图发现左心房有一肿块，遂进行手术切除。患者康复，但遗留右腓总神经麻痹，随后被转诊进行康复治疗。
对于有栓塞事件且既往无心脏病的年轻患者，必须考虑心脏内肿瘤。超声心动图是首选的诊断方法，必要时可辅以CT/MRI。手术切除可治愈，但可能出现再灌注综合征等并发症。由于存在复发风险，建议每年进行超声心动图检查进行长期随访。
本病例说明了早期诊断、多学科干预和协调护理对于患有急性栓塞事件的心脏黏液瘤患者取得良好预后的重要性。
