Atrial myxoma with metastasis misdiagnosed as Takayasu arteritis

Division of Rheumatology and Immunology, Department of Medicine, West China Hospital of Sichuan University, 37# Guoxue Road, Wuhou District, 610041, Chengdu, China.
Rheumatology International (Impact Factor: 1.52). 09/2009; 30(11):1499-502. DOI: 10.1007/s00296-009-1096-z
Source: PubMed


The objective of the study is to report a case of atrial myxoma with bloodstream metastasis misdiagnosed to be Takayasu arteritis. A 23-year-old woman manifested with fever, repetitive vasocerebral events and extremities ischemic signs (claudication, difference of BP in arms and absence of pulse) for 5 years. Imaging studies revealed multiple cerebral infarction, bilateral iliac artery stenosis and as thrombosis formation. Takayasu arteritis was diagnosed according to American College of Rheumatology criteria. Glucosteroids and immunosuppressants were given; however, symptoms were not relieved even after treatment. Echocardiography suggested a mass in left atrium, which was surgically removed and pathologically confirmed to be atrial myxoma. Clinical symptoms completely relieved after operation. In conclusion, atrial myxoma with bloodstream metastasis sometimes presented with similar clinical symptoms of Takayasu arteritis and may lead to misdiagnosis of these two diseases. Usually, accepted diagnosis criteria are not enough in distinguishing these diseases. Echocardiography should be considered in these patients.

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    ABSTRACT: Objective Patients with occult, undiagnosed cardiac myxomas (CM) often present with acute complications that mimic other, more common, conditions. We describe two recently encountered patients who classically demonstrate this phenomenon and report the results of an integrative review of CM cases to define the characteristics of such patients. Methods A comprehensive 20-year review of reported cases that described patient-specific data of CM was performed. Using a standardized tool, the following elements were collected: age; gender; presenting symptoms and signs; diagnostic and management approaches; and outcomes. Results 126 cases of CM were identified. The mean patient age was 47.5 years (range 6–90). 70 (56%) were women. The most common mimic conditions initially being considered were cardiac complications, including acutely decompensated heart failure, myocardial infarction, dysrhythmia and sudden death (46%); systemic embolization, including cutaneous infarction and pulmonary embolism (23%); central nervous system embolization, including transient ischemic attack and acute stroke syndrome (22%); and constitutional conditions, such as fever, myalgia, arthralgia, fatigue and myxoma infections (17%). Echocardiography proved to be a readily available and accurate diagnostic test. The majority of reported patients experienced full recoveries after surgical intervention. Conclusions CM is a rare but potentially life-threatening condition. Symptoms and signs relating to CM mimic other, more common conditions, resulting in diagnostic delay. Echocardiography can quickly and accurately diagnose CM and timely surgical intervention is curative. Clinician awareness of this condition, in a suggestive clinical context, will increase the likelihood of optimal patient outcome.
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    ABSTRACT: Lesson We describe the case of a 48-year-old woman whose atrial myxoma was mistaken for vasculitis. The case report highlights the reasons why these two disorders may become confused, the dangers of initiating the wrong treatment and a simple means of avoiding misdiagnosis.
    Full-text · Article · Nov 2014