Angiographic demonstration of blood supply of right atrial myxoma

A 53-year-old woman underwent cardiac catheterization for assessment of coronary arterial disease. An unexpected finding of a gradient between right atrium and right ventricle led to the discovery of an unsuspected right atrial myxoma. The diagnosis was established by the presence of a filling defect in the right atrial angiocardiogram and by the demonstration of "tumour vessels" by selective right coronary angiography. Selective coronary angiography can visualize the blood supply to an intracardiac tumour and thus confirm the diagnosis preoperatively.     

Simulation of right atrial cardiac myxoma by silent hepatocellular carcinoma

A clinically silent hepatocellular carcinoma presenting as a mixoma of the right atrium is described. Intra-atrial growth has been reported in advanced, clinically manifested cases of liver carcinomas in African and Japanese subjects, but very occasionally in Caucasian people. Our case further suggests that this occurrence should also be considered in Western Countries.     

Unique association of a rapidly growing right atrial myxoma in a child with double-outlet right ventricle

We have undertaken an analysis of semen from HIV infected men with regard to sperm counts and motility, non-spermatozoal cells, and viral nucleic acid. Regression analysis showed that sperm concentration and motility were positively associated with blood CD4 cell count. By contrast, non-spermatozoal cell concentration (round cells) was inversely related to CD4 count. Extracellular HIV RNA was detected in the majority of semen samples and proviral DNA in a minority. Percoll gradient washing of 12 semen samples yielded six samples containing adequate sperm concentration for analysis. This washing procedure reduced prewash extracellular RNA to below detectable limits in all cases; proviral DNA present in two of the six prewash samples was also reduced to below detectable limits after washing. We conclude that semen washing before artificial insemination may reduce the risk of HIV transmission from an infected man to an uninfected woman. However, further evidence from prospective analyses of such an approach is required.     

Infected atrial myxoma

A patient with an infected atrial myxoma presented with clinical findings simulating bacterial endocarditis. The diagnosis was made with echocardiography, thus demonstrating the value of this rapid, noninvasive screening test. A ruptured mycotic aneurysm in the brain precluded early surgical excision of the tumor. The rapid evolution of this case to a fatal outcome underscores the need for prompt diagnosis.     

Acute bicaval obstruction as a result of intracapsular haemorrhage in a right atrial myxoma: report of a case

Right atrial myxomas are rare and presentation is characterised by the gradual onset of one or more of a triad of constitutional, obstructive, or embolic symptoms. We describe a case in which interstitial haemorrhage within a right atrial myxoma resulted in rapid expansion and presentation with features of rapidly progressing bicaval obstruction and atrial flutter. Transthoracic echocardiography failed to detect this tumour; however, transoesophageal echo clearly displayed it and gave information on its attachment and relations which proved to be valuable in the planning of its surgical excision.     

An unusual site of cardiac myxoma. Apropos of a case in an 11-year old child

Cardiac myxoma, a relatively common condition in adults, is exceptionally rare in childhood. It is usually observed in the left atrium. The condition may be latent and a chance echocardiographic finding or present with arrhythmias, intermittent mitral obstruction or embolic phenomena. The authors report the case of an 11-year old child with no previous medical history, admitted to hospital after sudden right hemiplegia due to an ischaemic cerebrovascular accident. The investigation of a cardiac embolic abnormality led to the finding of a very large left ventricular tumour inserted into the mitral annulus and prolapsing into the left ventricular outflow tract, the histological examination of which confirmed the diagnosis of myxoma. Cardiac myxomas in children seem to have a much more variable site of implantation than in adults, especially in the right heart in infancy. Treatment is always surgical. Echocardiography should be requested early in children presenting with a murmur of recent origin, malaises, or unexplained inflammatory syndromes, and would seem to be the only means of avoiding the severe embolic complications of these histologically benign tumours.     

An unusual case of ectopic atrial tachycardia: triggered activity as an arrhythmogenic mechanism

We report a rare case of ectopic atrial tachycardia induced by ergometric stress test whose arrhythmogenic mechanism, after transesophageal electrophysiological study, seemed to be triggered activity. The patient was successfully treated with a beta-blocker (metoprolol), confirming the importance of autonomic modulation in the genesis of arrhythmias caused by afterdepolarizations.     

Right atrial myxoma presenting as nonresolving pulmonary emboli: case report

A case of right atrial myxoma causing extensive pulmonary embolization is described. Five years elapsed between the initial consultation and the correct diagnosis. The patient has been free of symptoms for 3 years following surgical removal of the tumor. The clinical manifestations of right atrial myxoma, the differential diagnosis, and the atypical lung-scan features are discussed.     

Coronary artery fistula with left atrial myxoma: report of a case

A 64-year-old male was referred for surgical treatment of left atrial myxoma. Preoperative coronary angiography revealed coronary artery fistula from the left anterior descending artery and the circumflex artery draining into the main pulmonary artery. Operative treatment was performed including resection of the myxoma, patch closure of the atrial septal defect, and closure of the fistula with pledgeted mattress sutures from within the main pulmonary artery on cardiopulmonary bypass. His postoperative course was uneventful, and disappearance of the left atrial myxoma and the coronary artery fistula was ascertained by echocardiography and coronary angiography.     

Polymyalgia syndrome and atrial myxoma

We present a case of polymyalgia-like syndrome in a 62-years-old woman with four month history of severe headache, muscular claudication, asthenia, normochromic, normocytic anaemia and elevation of erytrocyte sedimentation rate. A diagnosis of giant left atrial myxoma was made brought about by thoracoabdominal magnetic resonance. Their surgical exeresis was followed by gradual disappearance of symptoms and normalization of laboratory parameters.     

Surgical removal of right atrial myxoma with severe hypoxemia caused by right to left shunt through persistent foramen ovale]

A 41-year-old woman was referred to our hospital due to dyspnea and cyanosis. Echocardiography revealed a right atrial tumor with right to left shunt through PFO. There was no evidence of pulmonary embolism from the tumor. The tumor was removed under cardiopulmonary bypass and PFO was closed. The patient is doing well now.     

An unusual case of cor triatriatum

Cor triatriatum (CT) is a rare congenital cardiac anomaly. A case is presented of subdivided left atrium, corrected surgically, which can be considered a type of CT not previously reported.     

An unusual case of cadaver dismemberment

The authors present a case of dismemberment that is exceptional because of the small size and impressive number of fragments (538 excluding the internal organs). The head was intact, allowing classical identification through comparison of the dentition with the dentist's record. The cause of death could not be ascertained, though it can be supposed that the victim had been killed by sharp force.     

An unusual case of Creutzfeldt-Jakob disease

A patient with histopathologically verified sporadic Creutzfeldt-Jakob disease (CJD) presented initially with diplopia, sleep disturbances, and L-dopa-responsive parkinsonism. After more than a year of slow progression, he did not become demented, and failed to fulfill the clinical criteria for possible CJD. No clinical examinations currently proposed to detect CJD showed the disease. CJD should be in the differential diagnosis of "parkinson plus" syndromes until a different etiology has been found or a histopathologic examination performed.