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.