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Cardiac myxoma presenting with multisystem involvement

Ghofran A. Ageely, Salhah S. Alsulami, Ahad A. Alkenani and Ebtihal EMS. Albeshri
Saudi Medical Journal September 2022, 43 (9) 1057-1061; DOI: https://doi.org/10.15537/smj.2022.43.9.20220346

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    - Brain magnetic resonance imaging showing: A) postcontrast coronal view demonstrating enhancing sellar mass with suprasellar extension giving the Snowman sign, typical for pituitary macroadenoma, there is also mild ventricular dilatation; B) susceptibility weighted imaging revealing blooming in the Sylvian fissure and sulci representing subarachnoid haemorrhage, in the posterior horns of the lateral ventricles representing intraventricular haemorrhage and in the suprasellar part of the pituitary macroadenoma in keeping with pituitary apoplexy; C) FLAIR; and D) postcontrast images demonstrating multiple white matter hyperintense foci without enhancement representing small vessel disease/infarctions.

  • Figure 2
    Figure 2

    - Enhanced computed tomography axial images demonstrating: A) 4.7 cm left atrial mass based on the interatrial septum at fossa ovalis typical for atrial myxoma, additionally, there is a left lower lobe mass; B) a large left thyroid lobe mass ; and C) a small left adrenal mass.

  • Figure 3
    Figure 3

    - Echocardiography demonstration 48 mm left atrial mass attached to the fossa ovalis of the /atrial septum typical for cardiac myxoma.

Tables

  • Table 1

    - Sequence of events.

    DaysEvents
    Day oneCT brain showed sellar/suprasellar mass with mild ventricular dilation.
    Day 2MRI brain showed a sellar mass with suprasellar extension and old subarachnoid and intraventricular haemorrhage.
    Day 8CT chest and abdomen and echocardiography revealed multi-organ lesions.
    Day 9The patient developed generalized seizures controlled by Levetiracetam.
    Day 10CT brain revealed acute intraventricular haemorrhage with worsening communicating hydrocephalus.
    Day 13An external ventricular drain was inserted for decompression of the hydrocephalus.
    Day 16He was intubated on mechanical ventilation due to a sudden drop in GCS and worsening seizures. Repeated CT brain showed a new acute parietal intracerebral haemorrhage and MRI revealed no aneurysm or vascular abnormality.
    Day 53Brain MRI showed right occipital acute infarction.
    Day 65CT brain showed a right occipital hemorrhagic transformation.
    Day 86Cardiac arrest and death.

    CT: computed tomography, MRI: magnetic resonance imaging, GCS: Glasgow coma scale

    • Table 2

      - Patient’s biochemical profile.

      Laboratory investigationsResults
      Serum sodium135 (136-145 Nmol/L)
      Serum potassium4.5 (3.6-5.2 mmol/L)
      Serum chloride103 (96-106 mmol/L)
      TSH0.101 (0.45-4.5 mU/L)
      Free T48.33 (12-30 pmol/L)
      Free T32.57 (2-7 pmol/L)
      Random glucose3.9 (3.9-5.6 mmol/L)
      Random cortisol2070 (136-636 Nmol/L)
      ACTH1.11 (1.6-13.9 pmol/L)
      GH0.093 (0.4-10 Ng/ml)
      IGF15 (85-95 Ng/ml)
      FSH8.93 (1.5-12.4 IU/L)

      TSH: thyroid stimulating hormone, T4: thyroxine, T3: triiodothyronine, ACTH: adrenocorticotropic hormone, GH: growth hormone, IGF: insulin-like growth factor, FSH: follicular stimulating hormone

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