Korean Circ J.  2016 Nov;46(6):875-878. 10.4070/kcj.2016.46.6.875.

Differential Diagnosis of a Left Atrial Mass after Surgical Excision of Myxoma: a Remnant or a Thrombus?

• Park H
• Jo S
• Cho YK
• Kim J
• Cho S
• Kim JH
• Jeong YJ
• Song JK

• KMID: 2355467
• DOI: http://doi.org/10.4070/kcj.2016.46.6.875

Abstract

Echocardiographic diagnosis of atrial myxoma may not always be straightforward, and the distinction between myxoma and thrombi is not easy, especially when we observe a mass after successful surgery. Our report describes a 72-year-old woman who presented with right upper limb hemiparesis and was subsequently diagnosed as having transient ischemic attack due to a left atrial myxoma. One month after successful surgical resection of the tumor, the patient developed left-sided weakness. Echocardiography revealed a left atrial mass attached to the interatrial septum. Intravenous heparin was administered as a therapeutic trial for postoperative thrombi, which resulted in a decrease in mass size within a week. Anticoagulation with warfarin was continued, and complete resolution was demonstrated on a 4-month follow-up transesophageal echocardiography. This case highlights the fact that thrombus formation at the surgical site should be considered an unusual but potential complication after surgical resection of left atrial myxomas.

Keyword

Myxoma; Thrombosis; Echocardiography

MeSH Terms

Aged
Diagnosis
Diagnosis, Differential*
Echocardiography
Echocardiography, Transesophageal
Female
Follow-Up Studies
Heparin
Humans
Ischemic Attack, Transient
Myxoma*
Paresis
Thrombosis*
Upper Extremity
Warfarin
Heparin
Warfarin

Figure

• 

  Fig. 1 Transthoracic echocardiographic images before (upper panel, A and B) and after surgical removal of a LA myxoma (lower panel, C and D). LV: left ventricle, RV: right ventricle.

• 

  Fig. 2 Serial transesophageal echocardiographic images before surgery (A), before anticoagulation (B), one week (C) and 4 months after anticoagulation (D).

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