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Cerebellar embolization in patients with heart murmur.
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MedLine Citation:
PMID:  22111057     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
A 76-year-old female present to the emergency department with dysarthria, dizziness, dyspnea. The patient had hypertension and atrial fibrillation. Brain MRI revealed right cerebellar infarction. Transthoracic echocardiography showed a large round mass in the left atrium. Transesophageal echocardiography showed large complex echogenic round mass lesion attached on left atrial side of interatrial septum. Coronary angiogram revealed round movable mass lesion in left atrium with feeding arteries originated from right coronary artery. She underwent removal of mass and Maze operation, and pathologic finding was compatible with myxoma.
Authors:
Min Goo Lee; Jong Chun Park; Byoung Hee Ahn; Myung Ho Jeong
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Publication Detail:
Type:  Journal Article     Date:  2011-04-26
Journal Detail:
Title:  Chonnam medical journal     Volume:  47     ISSN:  2233-7393     ISO Abbreviation:  Chonnam Med J     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-11-23     Completed Date:  2011-11-23     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101564659     Medline TA:  Chonnam Med J     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  45-7     Citation Subset:  -    
Affiliation:
The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
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Journal Information
Journal ID (nlm-ta): Chonnam Med J
Journal ID (publisher-id): CMJ
ISSN: 2233-7385
ISSN: 2233-7393
Publisher: Chonnam National University Medical School
Article Information
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© Chonnam Medical Journal, 2011
open-access:
Received Day: 26 Month: 3 Year: 2011
Accepted Day: 05 Month: 4 Year: 2011
Print publication date: Month: 4 Year: 2011
Electronic publication date: Day: 26 Month: 4 Year: 2011
Volume: 47 Issue: 1
First Page: 45 Last Page: 47
ID: 3214863
PubMed Id: 22111057
DOI: 10.4068/cmj.2011.47.1.45

Cerebellar Embolization in Patients with Heart Murmur
Min Goo LeeA1
Jong Chun ParkA1
Byoung Hee AhnA1
Myung Ho JeongA1
The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Correspondence: Corresponding Author: Myung Ho Jeong. Department of Internal Medicine, Chonnam National University Medical School, 8, Hakdong, Dong-gu, Gwangju 501-757, Korea. TEL: +82-62-220-6243, FAX: +82-62-228-7174, mhjeong@chonnam.ac.kr

WHAT IS THE CAUSE OF RIGHT CEREBELLAR INFARCTION?

A 76-year-old female presented to the emergency department with the main complaint of 7 days of dyspnea and 1 day of dysarthria and dizziness. She had a history of hypertension. Auscultation findings showed an irregular heart beat with a diastolic rumbling murmur in the apical region and crackles in both lower lung fields. The electrocardiogram showed an irregular pattern corresponding to atrial fibrillation. Brain MRI showed findings compatible with right cerebellar infarction (Fig. 1). Transthoracic echocardiography showed a moderate degree of aortic regurgitation with left ventricular (LV) ejection fraction of 70.8% and a 1.63×1.31-cm complex, echogenic, round, mass-like lesion attached to the left atrial side of the interatrial septum. Transesophageal echocardiography revealed the same mass finding with prominent spontaneous echo contrast in the left atrium and decreased emptying velocity of the left atrial appendage (Fig. 2). The diagnostic coronary angiogram revealed a round, movable mass lesion in the left atrium with feeding arteries originating from the conus branch and atrioventricular nodal artery of the right coronary artery and no significant stenosis in either coronary artery (Fig. 3). The patient was transferred to cardiac surgery and underwent removal of the mass and a Maze operation.


THE DIAGNOSIS: LEFT ATRIAL MYXOMA

The resected mass had an oval shape and was 2.0×2.0×1.5 cm in size. Macroscopic findings were compatible with myxoma, and the microscopic findings revealed an acid mucopolysaccharide-rich stroma composed of a myxoid matrix and polygonal cells with scant eosinophilic cytoplasm scattered throughout the matrix (Fig. 4). After surgery, the atrial fibrillation was abolished and an electrocardiogram showed a normal sinus rhythm. Follow-up transthoracic echocardiography was performed after surgery and no remnant mass was observed in the left atrium (Fig. 5). At present, the patient is admitted to outpatient department regularly and has taken aspirin and angiotensin receptor blocker steadily without specific problems.

The presence of possible tumor vessels originating from coronary arteries may be helpful in the decision on an operative strategy for cardiac myxoma. About 52% of cardiac myxoma is visualized by coronary angiograms according to previous reports, but catheterization of the chamber from which the tumor arises carries the risk of tumor embolization.


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4. Burke A,Jeudy J Jr,Virmani R. Cardiac tumours: an update: cardiac tumoursHeartYear: 20089411712318083956
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6. Kuroczyński W,Peivandi AA,Ewald P,Pruefer D,Heinemann M,Vahl CF. Cardiac myxomas: short- and long-term follow-upCardiol JYear: 20091644745419753524
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Article Categories:
  • Images in Clinical Medicine

Keywords: Neoplasms, Heart, Embolization.

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