We describe a case of establishing cardiopulmonary bypass (CPB) before general anesthesia in a person who has an obstructive right atrial myxoma protruding into the right ventricle (RV). A 27-year-old female endorsed shortness of breath on exertion, dry cough, and palpitations, with a cardiac MRI exhibiting a severely enlarged right atrium (RA) with a 65 mm x 40 mm mass. The mass obstructed the tricuspid valve from closing and extended into the RV, leading to an ejection fraction (EF) of 49%. The obstruction caused concern for cardiovascular collapse due to hypotension and bradycardia that may be provoked by inducing general anesthesia. Under local sedation, the femoral vessels were cannulated, CPB was initiated, and the patient received general anesthesia. A median sternotomy was completed, and traditional CPB was established. After the heart was arrested, the RA was opened, and the mass was resected along with a full-thickness section of the RA. This case report supports preoperative CPB for patients undergoing general anesthesia to correct a cardiac mass that is obstructing central venous return.

Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical-Etiological-Anatomical-Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes.

An ectopic kidney (EK) and cardiac myxoma are two distinct conditions with no known direct association. Cardiac myxoma represents the most common benign primary cardiac tumor, arising from the endocardium. In contrast, an EK is a congenital anomaly characterized by one or both kidneys being located outside their normal position within the renal fossa. We present the case of a 27-year-old female patient who was evaluated for ischemic stroke and was found to have a left atrial myxoma originating from the interatrial septum (IAS) and prolapsing into the right atrium through an atrial septal defect (ASD). During transthoracic echocardiographic (TTE) evaluation, a hypoechogenic structure suggestive of a mass was observed within the inferior vena cava (IVC). However, multimodality imaging, including contrast-enhanced computed tomography (CT), demonstrated that this finding represented external compression caused by a right EK rather than a true intravascular mass. This case underscores the importance of multimodality imaging in distinguishing true intravascular lesions from external anatomical impressions and highlights that an EK may mimic an IVC mass on echocardiography. Furthermore, the report documents a rare concurrence of cardiac myxoma, ASD, thoracic EK, and an ectopic adrenal gland.

Cardiac myxomas are rarely diagnosed in pregnancy.

Cardiac myxomas typically demonstrate slow growth rates, with rapid enlargement raising suspicion for malignancy. We present a 77-year-old male with a history of non-Hodgkin lymphoma who developed symptomatic atrial fibrillation. Transthoracic echocardiography revealed a left atrial mass measuring 2.5 cm that was absent six months earlier, suggesting a growth rate of approximately 5 mm/month. Multimodality imaging including transesophageal echocardiography, cardiac CT, and MRI showed features suggestive of myxoma but could not definitively exclude lymphoma recurrence given the patient's oncological history and atypical growth pattern. Thoracoscopic resection was successfully performed. Histopathology confirmed a cardiac myxoma with central necrosis-a rare finding occurring in less than 3% of cases-which likely contributed to the unusually rapid growth. This case highlights the diagnostic value of multimodality imaging and the importance of multidisciplinary decision-making in managing complex cardiac masses.

Primary cardiac intimal sarcoma is an exceptionally rare and aggressive malignant tumour that often mimics benign cardiac lesions, particularly atrial myxoma. Accurate diagnosis requires multimodality imaging and histopathological confirmation.

Cardiac myxomas are rare in children and can mimic other conditions. We report a 14-year-old boy initially diagnosed with acute poststreptococcal glomerulonephritis based on hematuria, mild proteinuria, and elevated anti-streptolysin-O titers. However, worsening dyspnea, edema, and signs of heart failure prompted further evaluation. Echocardiography revealed a large left atrial mass with impaired biventricular function and tricuspid regurgitation. Surgical excision confirmed a myxoma. The patient's renal and systemic symptoms were attributed to low cardiac output and venous congestion, not true glomerulonephritis. This case highlights the need to consider cardiac causes in pediatric patients with persistent nephritic-like features.

Cardiac myxoma is a rare benign primary cardiac tumor in children with a high risk of cerebral embolization due to its friable and mobile nature. We present a child who developed an acute left middle cerebral artery infarct from embolization from a left atrial myxoma. He underwent decompressive craniectomy followed by myxoma resection 5 days later. Perioperative management focused on neuroprotection, including mild hypothermia, cerebral oximetry monitoring, and optimized hemodynamic and metabolic parameters. No hemorrhagic complications occurred, and the patient had a favorable neurological recovery without tumor recurrence. In myxoma-related embolic stroke, surgical resection remains the definitive treatment. Although the timing of surgery remains debated, delaying surgery even with antithrombotic bridging still poses a risk of recurrent embolism. With multidisciplinary coordination to balance the risks of hemorrhagic transformation and further embolization, early surgery can be both safe and effective.

Stroke is a major cause of death worldwide, with most cases being ischemic in presentation. Cardioembolic phenomenon contributes to a significant number of ischemic strokes. Cardiac myxomas, although generally benign, are the most common tumors arising in the left atrium. Left atrial tumors tend to grow into the atrial lumen and can cause symptoms similar to heart failure with mitral valve disease. Cardiac myxomas have typical pedunculated, gelatinous features and are at risk of microthrombi formation. However, when these typical features are not present, sessile cardiac myxomas can be mistaken for lipomatous hypertrophy of the interatrial septum. Embolic phenomenon from myxoma microthrombi can lead to serious neurological complications, which can be difficult to diagnose. We present a case of an 82-year-old male patient with multiple strokes and findings of left atrial myxoma with atypical features. This case illustrates the diagnostic challenge posed by atypical cardiac myxoma morphology leading to recurrent embolic stroke. Advanced cardiac imaging, beyond a transthoracic echocardiogram, may be warranted when evaluating cryptogenic stroke to rule out cardiac myxomas.