An unusual presentation of right atrial myxoma: a case report
Dr Debmalya Saha1, Dr Lakshmi Sinha1, Dr Satyajit Samal1, Dr Sayyed Ehtesham Hussain Naqvi2, Dr Muhammad Abid Geelani3
1MCh Senior Resident
2Assistant Professor
3Director & Professor, Head of the Department
Department of Cardiothoracic & Vascular Surgery (CTVS)
G.B. Pant Institute of Postgraduate Medical Education & Research (GIPMER), New Delhi-110002, India
Corresponding author: Dr Debmalya Saha
Email: debmalya.cmc@gmail.com
Contact No. +91-8444802200
ABSTRACT: A right atrial myxoma extending to inferior vena cava (IVC) with associated right-to-left shunting leading to systemic desaturation is an exceedingly rare clinical entity. The number of such cases reported in literature till date is not more than five. This case study presents a 45-year lady who was referred to our Centre with symptoms of breathlessness, easy fatigability, generalized weakness andbluish discoloration of lips, fingers and skin . On routine blood investigation polycythemia was noted. On preoperative 2D-Transthoracic Echocardiography (TTE), the diagnosis of right atrial myxoma was confirmed but reason of cyanosis was not revealed. Tumor thrombus in a branch of right lower pulmonary artery with small locoregional pulmonary infarct along with right atrial myxoma was reported in CT angiography of heart and great vessels and CT pulmonary angiography. On-table Transesophageal Echocardiography (TEE) showed patent foramen ovale (PFO) with right-to-left shunting because of raised right atrial pressure and dynamic obstruction of the tricuspid valve by the myxoma. The myxoma was resected completely via right atrial approach along with primary closure of PFO. Post-operative period was uneventful and the saturation at room air of the patient was 100% and she was discharged on day 7. The Patient is doing well during the 3-month follow-up.
KEYWORDS: atrial, myxoma, cyanosis, shunt
INTRODUCTION: Right atrial myxoma extending to IVC with right-to-left shunting resulting in systemic desaturation is rare. Here we will present a right atrial myxoma with IVC extension withcyanosis in a 45-year female after proper informed and written consent obtained from the patient.
CASE REPORT: A 45-year female was referred to our Centre with symptoms of shortness of breath, easy fatigability, generalized weakness and bluish discoloration lips, fingers and skin for about four months. On general examination patient was malnourished and thin built; central cyanosis was present. On auscultation grade 3/6 diastolic murmur was audible at tricuspid region. Other systems were normal.
Polycythemia was detected in routine blood investigation. Arterial blood gas (ABG) analysis showed pO2 of 32mm Hg and SpO2 of 68% at room air and 72% on oxygen (nasal prong/face mask).
Chest X-ray revealed no abnormality. 2D-Transthoracic Echocardiography (TTE), the diagnosis of right atrial myxoma was confirmed but reason of cyanosis was not revealed. Tumor thrombus in a branch of right lower pulmonary artery with small locoregional pulmonary infarct along with right atrial myxoma was reported in CT angiography of heart and great vessels and CT pulmonary angiography. Cardiac catheterization study was not possible due to ongoing COVID pandemic and institutional COVID-19 testing protocol. We still had diagnostic dilemma between right atrial myxoma with right-to-left shunting and pulmonary thromboembolism.