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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 94-95

Right atrial myxoma: A rare cause of cannon ball opacity in lung


1 Department of Respiratory Medicine, Venereology and Leprosy, Government Medical College, Kota, Rajasthan, India
2 Department of Radio Diagnosis and Modern Imaging, Venereology and Leprosy, Government Medical College, Kota, Rajasthan, India
3 Department of Dermatology, Venereology and Leprosy, Government Medical College, Kota, Rajasthan, India

Date of Web Publication10-Jun-2016

Correspondence Address:
Moti Lal Bunkar
Department of Respiratory Medicine, Government Medical College, Kota, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-8775.177508

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How to cite this article:
Bunkar ML, Takhar R, Jangid V, Choudhary P, Arya S. Right atrial myxoma: A rare cause of cannon ball opacity in lung. J Assoc Chest Physicians 2016;4:94-5

How to cite this URL:
Bunkar ML, Takhar R, Jangid V, Choudhary P, Arya S. Right atrial myxoma: A rare cause of cannon ball opacity in lung. J Assoc Chest Physicians [serial online] 2016 [cited 2019 Sep 15];4:94-5. Available from: http://www.jacpjournal.org/text.asp?2016/4/2/94/177508

Dear Sir,

A 45-year-old man, with no significant medical history, came to the outpatient department with the chief complaints of dry cough, dull aching diffuse chest pain for 1-month duration, and orthopnea of 7 days. He was a nonsmoker, nondiabetic, and not to consume alcohol. He denied for fever, hemoptysis, anorexia, weight loss, dysphagia, nausea, vomiting, and pedal o\edema. On physical examination, he was averagely built and nourished with moderate pallor. The jugular venous pressure was normal with no peripheral lymphadenopathy. Chest examination revealed bilateral basal crepitations on auscultation with splitting of S1 heart sound and no murmurs. Nothing abnormal was detected on examination of other systems.

His chest skiagram posterior-anterior (PA) view showed bilateral infiltrated pulmonary lesions, mostly distributed in periphery including mid and lower zones, integrating or coalescing with each other, depicting rounded opacities. The cardiac silhouette was also enlarged on the right side [Figure 1]a. All routine blood investigation was within normal limits including Human immunodeficiency virus serology. Transthoracic echocardiography showed moving mass in the right atrium (RA) attached to atrial septum with increased RA and right ventricular volume overload [Figure 1]b.
Figure 1: (a) Chest skiagram posterior-anterior view showed bilateral infiltrated pulmonary lesions, distributed in periphery including mid and lower zones, integrating or coalescing with each other, depicting rounded opacities with enlarged right cardiac silhouette. (b) Transthoracic echocardiography showed moving mass in right atrium attached to atrial septum

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Mediastinal window of contrast-enhanced computerized tomography scan of the chest showed an enlarged cardiac silhouette with an intra-atrial hypodensity in RA measuring about 3 cm × 2 cm and avoiding of filling of RA with contrast medium, suggestive of myxoma. Lung window showed ground glass haziness with areas of patchy consolidation and multiple nodular lesions suggesting metastatic lesions [Figure 2]a,[Figure 2]b,[Figure 2]c. Patient underwent median sternotomy under general anesthesia, and the tumor was resected. Histopathology showed round, oval, polygonal, or stellate cells in an abundant loose myxoid matrix containing abundant mucopolysaccharides, overall expressive of myxoma [Figure 3]. A right atrial myxoma with embolic metastasis to lung was made as the final diagnosis. Unfortunately, on the 2nd postoperative day, our patient got supraventricular tachycardia followed by cardiac arrest and was no more. Atrial myxoma is one of the primary cardiac tumor with an incidence of 0.0017–0.19%, demonstrating <5% of all heart tumors. Right atrial myxoma is uncommon and occurs in 15–20% cases of myxoma.[1] Mostly affecting women with an age predilection of third to sixth decades. Early diagnosis for intracardiac tumor is difficult due to nonspecific symptoms. The signs and symptoms of RA myxoma are atypical and highly variable, depending on the size, position, and mobility of the tumor and are modified according to physical activity and body position of the patient.[2] Symptoms also occur due to endomyocardial flow obstruction or peripheral embolization. Constitutional symptoms such as fever, malaise, and weight loss have been attributed to cardiac myxoma releasing the cytokine, interleukin-6 which causes inflammatory and autoimmune manifestations.[3] As in our case symptoms are nonspecific and occur after pulmonary involvement due to hematogenous spread of tumor foci. The Development of pulmonary metastases implies a disseminated disease, with poor prognosis, however, cases are sparse. The embolic metastases occur because of right atrial myxoma, renal cell carcinoma, and hepatocellular carcinoma.[4] These form of metastasis confused with cannon ball secondaries. This case highlights a rare presentation of right atrial myxoma with nonspecific symptoms related to the malignancy itself but presented with symptoms related to pulmonary involvement.
Figure 2: (a) Mediastinal window of contrast-enhanced computerized tomography scan of the chest showed an enlarged cardiac silhouette with an intra-atrial hypo density in right atrium measuring about 3 cm × 2 cm and avoiding of filling of right atrium with contrast medium, suggestive of myxoma. (b) Lung window showed ground glass haziness with areas of patchy consolidation. (c) Multiple nodular lesions suggesting metastatic lesions

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Figure 3: Histopathology showed round, oval, polygonal, or stellate cells in abundant loose myxoid matrix containing abundant mucopolysaccharides, overall expressive of myxoma

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nina VJ, Silva NA, Gaspar SF, Rapôso TL, Ferreira EC, Nina RV, et al. Atypical size and location of a right atrial myxoma: A case report. J Med Case Rep 2012;6:26.  Back to cited text no. 1
    
2.
Oliveira R, Branco L, Galrinho A, Abreu A, Abreu J, Fiarresga A, et al. Cardiac myxoma: A 13-year experience in echocardiographic diagnosis. Rev Port Cardiol 2010;29:1087-100.  Back to cited text no. 2
    
3.
Ojji DB, Ajiduku SS, Omonua OO, Abdulkareem LL, Parsonage W. A probable right atrial myxoma prolapsing through the tricuspid valve into the right ventricle: A case report. Cases J 2008;1:386.  Back to cited text no. 3
    
4.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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