Giant Left Atrial Myxoma Causing Arthralgia and Fever

Year 2013, Volume: 14 Issue: 1, 47 - 50, 01.04.2013

Ahmet Huyut , Çağdaş Akgüllü Ufuk Eryılmaz

Abstract

Myxoma, which is the most common primary tumour of the heart, is commonly located in the left atrium.
Although intra cardiac myxomas are histologically benign, they may be the source of cerebrovascular emboli,
cause of mitral stenosis and nonspecific systemic complaints like fever and arthralgia. A55-year-old woman was
followed by rheumatology clinic because of sub-febrile fever and arthralgia for 6 months. She was admitted to our
clinic with complaints of dyspnea and orthopnea. Transthoracic echocardiography showed giant myxoma in the
left atrium. Transmitral pressure half time (PHT) was assessed by continuous wave doppler and measured
2 maximum/mean 29/17 mmHg transmitral gradient. Mitral valvular area was measured 1,6 cm by PHT. We
demonstrated a mass like myxoma, which originates from interatrial septum and caused functional mitral valve
stenosis, size of 55x31 mm by trans-eosophageal echocardiogram. Surgery was performed and the intracardiac
mass was removed. Pathological examination demonstrated myxoma. We report a patient of a huge left atrial
myxoma with functional mitral valve stenosis and complaints of sub-febrile fever and arthralgia. 2 months after
the operation the patient's subfebrile fever disappeared and complaints of arthralgia decreased. The complaints
completely disappeared and sedimentation rate was normal after 4 months. Sub-febrile fever and arthralgia was
suggested to be secondary to myxoma

Keywords

Myxoma, heart neoplasms, pathology, arthralgia, sub-febrile fever

References

• Reynen K. Cardiac myxomas. N Engl J Med ;333(24):1610-7.
• Burke A, Virmani R. Atlas of tumour pathology. Tumours of the heart and great vessels. Washington, DC: Armed Forces Institute of Pathology, 1996:1-11.
• Endo A, Ohrahara A, Kinugawa T, Mori M, Fujimoto Y, Yoshida, et al. Characteristics of 161 patients with cardiac tumors diagnosed during 1993 and 1994 in
• Japan. Am J Cardiol 1997;79(12):1708-11.
• Colucci WS, Schoen FJ. Primary tumors of the heart. In: Braunwald E, Zipes DP, Libby P, editors. Heart disease, A textbook of cardiovascular medicine. Philadelphia, WB Saunders, 2001:1807-22.
• Grande AM, Ragni T, Vigano M. Primary cardiac tumors: a clinical experience of 12 years. Texas Heart Inst J 1993;20(3):223-30.
• Fernandes F, Soufen HN, Lanni BM, Arteaga E, Ramires FJA, Mady C. Primary neoplasms of the heart: clinical and histological presentation of 50 cases. Arq Bras Cardiol 2001;76(3):231-7.
• Séguin JR, Beigbeder JY, Hvass U, Langlois J, Grolleau R, Jourdan M, et al. Interleukin 6 production by cardiac myxomas may explain constitutional s y m p t o m s . J T h o r a c C a r d i o v a s c S u r g ;103(3):599-600. Jourdan M, Bataille R, Seguin J, Zhang XG, Chaptal PA, Klein B. Constitutive production of interleukin-6 and immunologic features in cardiac myxomas. Arthritis Rheum 1990;33(3):398-402.
• Fyke FE 3rd, Seqard JB, Edwards WD, Miller FA Jr, Reeder GS, Schattenberg TT, et al. Primary cardiac tumors: Experience with 30 consecutive patients since the introduction of two-dimensional echocardiography. J Am Coll Cardiol 1985;5(6):1465-73. tümör olduðunu düþündürmektedir . 8
• St John-Sutton MG, Mercier LA, Giuliani ER, Lie JT. Her ne kadar þikayetler özellikli olmasa da, Atrial myxomas: a review of clinical experience in 40 patients. Mayo Clin Proc 1980;55(6):371-6. nefes darlýðýnýn gelip-geçici karakterde olmasý, pozisyonla deðiþmesi kalp içi kitleyi akla getirmelidir
• Ekokardiyografi; miksomalý hastalarýn taný ve tedavi sonrasý takiplerinde önemli bir yer tutmaktadýr . Miksoma tedavisinde standart yaklaþým cerrahi tedavidir. Kýsa ve uzun dönem yaþam beklentisi cerrahi ile oldukça yüksektir 10-13 . Bizim hastamýzda da tanýya ekokardiyografi ile ulaþýlmýþ ve erken dönemde Keeling IM, Oberwalder P, Anelli-Monti M, Schuchlenz H, Demel U, Tilz GP, et al: Cardiac myxomas: 24 year of experience in 49 patients. Eur J Cardiothorac Surg 2002;22(6):971-7.
• Hanson EC, Gill CC, Razavi M, Loop FD. The surgical treatment of atrial myxomas: clinical experience and late results in 33 patients. J Thorac Cardiovasc Surg ;89(2):298-303. Þahin M, Güler A, Demirkol S, Doðancý S, Yokuþoðlu M, Özal E, et al. Left atrial myxomas and surgical treatment. Gülhane Týp Dergisi 2011;53(1):38-42. YAZIÞMA ADRESÝ
• Yrd. Doç. Dr. Çaðdaþ AKGÜLLÜ Adnan Menderes Üniversitesi Týp Fakültesi, Kardiyoloji Anabilim Dalý, AYDIN, TÜRKÝYE E-Posta: [e-mail] Geliþ Tarihi Kabul Tarihi : 15.03.2013