Learning objectives
This case and associated images aims to promote awareness of left atrial myxoma (LAM) as a rare cause for cerebral aneurysms.
Background
Myxomas are a benign cardiac tumour, with over 75% arising in the left atrium.1 They may manifest in multiple ways, including obstructive symptoms, thromboembolic events and constitutional symptoms.1 Thromboembolic manifestations depend on the location of the atrial myxoma. Right-sided atrial myxoma may result in pulmonary emboli. Left-sided atrial myxoma may result in the development of fusiform cerebral aneurysms.2
Two theories describe the pathogenesis of aneurysm formation related to myxoma embolism. In one, aneurysm formation occurs due to embolic myxoma cells penetrating into the arterial wall2,...
Imaging findings OR Procedure details
We highlight the case of a female patient who initially presented complaining of hemianopia and dysarthria. Apart from hypertension and cigarette smoking, she was otherwise fit and well. There was no prior family history of cerebral aneurysms of note. Cerebral digital subtraction angiogram (DSA) was performed to exclude vasculitis as a cause for her presenting symptoms, and echocardiogram was undertaken to rule out embolic phenomenon. Her DSA was normal. An echocardiogram subsequently revealed a 5-centimetre left atrial myxoma, which was surgically resected. [Fig 1]
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Conclusion
Formation of cerebral aneurysms secondary to atrial myxoma is rare, with approximately 55 reported cases in the literature.2 This case is unusual in having documented normal vascular imaging several years prior to aneurysm development. We postulate that the embolic event could have occurred at the time of open cardiac surgery to remove the myxoma. A similar embolic mechanism is described in the development of multiple intracranial mycotic aneurysms in the setting of subacute bacterial endocarditis.5 Other risk factors for multiple cerebral aneurysms include autosomal dominant...
References
Nguyen T, Vaidya Y. Atrial Myxoma [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [updated 2022 Jul 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556040/.
Chojdak-Łukasiewicz J, Budrewicz S, Waliszewska-Prosół M. Cerebral Aneurysms Caused by Atrial Myxoma – A Systematic Review of the Literature. J Pers Med [Internet]. 2022 Dec 21;13(1):8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9861364/. doi: 10.3390/jpm13010008.
Sedat J, Chau Y, Dunac A, Gomez N, Suissa L, Mahagne MH, et al. Multiple cerebral aneurysms caused by cardiac myxoma. Interv Neuroradiol [Internet] 2007;13(2):179-184. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345481.
Sloane L, Allen JH, Collins HA....