Case Report of a 62-Year-Old Female with Ischemic Stroke Due to Embolization from Atrial Myxoma

Abstract

Myxomas are primary cardiac tumors of the most common pathology, with 75% of myxomas originating in the left atrium either at the mitral annulus or the fossa ovalis border of the interatrial septum; the remaining 20% come from the right atrium, and about 5% arise from both atria and the ventricle. Atrial myxomas are usually asymptomatic and are often detected when associated with complications due to tumor obstruction or emboli causing stroke. Due to the absence of symptoms, a diagnosis of a myxoma is often delayed until a significant embolic phenomenon, such as a stroke, occurs. We encountered such a scenario when a 62-year-old female presented to our hospital with right arm and leg weakness with her workup of stroke with a brain MRI showing numerous subacute infarcts consistent with embolic etiology. A routine transthoracic echo revealed a 2 × 5 cm atrial myxoma, which then led to the diagnosis of atrial myxoma along with a discovery of a patent foramen ovale (PFO), which subsequent surgical removal and PFO closure for definitive prevention of future embolic events. In this article, we aim to review the clinical presentation of cardiac myxoma along with appropriate investigations and treatment along with validation of the importance of timely echocardiograms with bubble studies in patients presenting with embolic stroke that can detect the atrial myxomas as a rare but potential cause of ischemic stroke.