199 A Giant Left Atrial Myxoma: An Atypical and Fortuitous Mode of Revelation Case Report

Abstract

A large atrial myxoma was discovered fortuitously in a patient that had a seizure, showing the importance of further investigations even after assuming a diagnosis.

A 63-year-old male with no medical issues was admitted to the emergency department after having tonic-clonic seizure. Initial examination found a hemodynamically stable patient scored 8/15 Glasgow, 48 hours later a contrast cerebral CT was performed showing no abnormalities, but electroencephalogram revealed epileptic foci in the left temporal-parietal territories. The staff decided to complete the investigations with a transthoracic echocardiography which visualised an enormous left atrial mass. A cardiac magnetic resonance imaging (CMR) confirmed the atrial mass, measuring (87*47) mm over 73mm attached to the interatrial septum with a surface of insertion of 30mm that does not protrude through the mitral valve. The patient underwent open heart surgery. Left atriotomy found a myxoid-looking mass adhering to the posterior-inferior wall of the left atrium of 11 cm over 5 cm. The patient was discharged uneventfully on his 8th post-operative day and pathoanatomical analysis revealed a myxoma. We oriented the patient to neurology after surgery and no complications were reported on his 3 months follow-up.

The aim of this case is to highlight three points: myxomas can remain asymptomatic for a long time despite their size, transthoracic echocardiography is a rapid and efficient bedside assessment, and a symptom can reveal more than one diagnosis.