A case of left atrial myxoma presenting with multiple embolic manifestations

Myxomas are the most common cardiac primary tumours. They account for 30 to 50 of all benign cardiac tumours. Seventy five percent of myxomas occur in the left atrium. The clinical presentations of cardiac myxoma varies from asymptomatic to symptoms of systemic manifestations , primary cardiac symptoms and those due to embolization . Tumor embolism is not an uncommon mode of clinical presentation and can affect the systemic or pulmonary circulation, depending upon the location of the tumor and the patency of the foramen ovale. Cardiac myxoma is the most common primary cardiac tumor to produce tumor emboli. It has been reported to embolize to any organ or tissue. Large saddle emboli in the abdominal aorta have been reported, causing acute lower limb ischemia.We are presenting a case of left atrial myxoma, presenting with aortoiliac and coronary arterial embolic manifestation . Our patient is a 42 year old female, presenting with one episode of syncope, followed by pain, numbness and weakness of right lower limb. Clinical examination showed weak lower limb pulses and a mid diastolic murmur in the mitral area. Electrocardiogram revealed symmetrical, deep T wave inversion in the precordial leads. Echocardiography showed left atrial myxoma and regional wall motion abnormality involving the left anterior descending coronary artery territory, with mild left ventricular dysfunction. Peripheral angiogram showed tumour embolus in the aortoiliac bifurcation. She underwent successful catheter embolectomy, followed by surgical removal of the left atrial tumour.