Left Atrial Myxoma Presenting with Catastrophic Systemic Embolization and Acute Limb Ischemia: A Case Report
Chin-Wai Lai, Sunny Chiu-Sun Yue, Tak-Shun ChungAbstract
Background
Cardiac myxomas are the most common primary cardiac tumors. While they can present with embolic events, catastrophic embolization causing acute limb ischemia is rare.
Case Presentation
A 63-year-old gentleman with no significant medical history presented with acute bilateral lower limb weakness, abdominal pain and atrial fibrillation (AF). Examination revealed signs of acute limb ischemia. Point-of-care ultrasound (POCUS) suggested an aortic thrombus, which was confirmed on urgent computed tomography (CT) angiography. CT revealed not only extensive thrombus in the aorto-iliac, renal, and mesenteric arteries, but also a 2.2 cm left atrial mass. The patient underwent emergency bilateral femoral embolectomy. Histology of the retrieved emboli confirmed a cardiac myxoma. Subsequent cardiac magnetic resonance imaging (MRI) characterized a 2.4cm left atrial mass, with features classical for myxoma. The patient underwent successful surgical excision of the tumor, an EnCompass MAZE procedure, and left atrial appendage closure. His postoperative course was complicated by fast atrial flutter but he made a full neurological recovery. At three-month follow-up, his left ventricular ejection fraction (LVEF) improved from 28% to 50% after satisfactory rate control with no residual mass or neurological deficits.
Conclusions
This case illustrates a rare presentation of left atrial myxoma with catastrophic systemic embolization. The concurrent AF should not prematurely terminate the diagnostic workup. Clinicians must routinely screen for occult cardiac embolic source via rapid imaging (e.g. POCUS and echocardiography) and secure definitive diagnosis through other advanced imaging and histopathology of the surgical specimen. Ultimately, a thorough diagnostic approach is essential to pave the way for prompt, multidisciplinary intervention that maximizes neurological and myocardial recovery. Given the risk of tumor recurrence, lifelong follow-up is mandatory.