Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

LETTER TO EDITOR
Year
: 2004  |  Volume : 14  |  Issue : 4  |  Page : 439--440

Left ventricular tumor presenting with systemic embolization


AY Lakshmi 
 Department of Radiology, SVIMS, Tirupati 517507, AP, India

Correspondence Address:
A Y Lakshmi
Department of Radiology, SVIMS, Tirupati 517507, AP
India




How to cite this article:
Lakshmi A Y. Left ventricular tumor presenting with systemic embolization.Indian J Radiol Imaging 2004;14:439-440


How to cite this URL:
Lakshmi A Y. Left ventricular tumor presenting with systemic embolization. Indian J Radiol Imaging [serial online] 2004 [cited 2020 Feb 26 ];14:439-440
Available from: http://www.ijri.org/text.asp?2004/14/4/439/28691


Full Text

Sir,

Left ventricular tumoral mass is a rare entity. Of them myxoma is cited as the commonest 1,2. They commonly present with constitutional features, aortic outflow disturbance in the form of stenotis or regurgitation and systemic or visceral manifestations as a result of embolization.VC, eighteen year old male presented with sudden onset weakness of both lower limbs with loss of sensations below the groins, of two days duration and hematuria of one day duration. This was preceded by abdominal pain and two episodes of vomitings. There was no suggestion of bladder involvement in the form of urinary retention or incontinence. There was no prior history of a fall, trauma or fever. He was treated for chest pain and breathlessness two months ago elsewhere but no details were available. Physical examination revealed flaccid paraplegia with loss of sensations from below groins, absent pulses in femorals, popliteals, tibials and dorsalis pedis of both lower limbs and presence of cardiac murmurs. Investigations were as follows: Hb 13.8gm%, TLC 16,900,Platelets 2.5 lakhs/cumm, B.urea 141mg%, S.creatinine 3.9 mg%, ECG- left ventricular enlargement with tented T waves, Echocardiography- a 2.5cm X 1cm intra cardiac mass attached to inter ventricular septum in left ventricle suggestive of myxoma, resulting in moderate aortic regurgitation and mild aortic stenotis like picture. Vascular Doppler- an intra luminal echogenic thrombus in distal aorta and proximal common iliacs completely occuluding the lumen, with reduced flow in superficial femorals, deep femorals, popliteals, anterior and posterior tibials on both sides. CECT- a thrombus in distal aorta near bifurcation extending into proximal common iliacs [Figure 1], splenic infarction [Figure 2] and bilateral renal infarctions [Figure 3]. Keeping in view of the above findings he was diagnosed to have sub aortic, intraluminal, inter ventricular septal tumor (myxoma) presenting with embolization resulting in paraplegia due to aortic obstruction, acute renal failure due to bilateral renal infarctions and splenic infarction. He was taken away by his relatives against medical advice after only one day's stay, before any definitive management could be offered.

A tumoral mass of left ventricle is a very rare entity 1,2.They often present with 1.constitutional syndromefever, weight loss, digital clubbing, leukocytosis, gamma globulinemia, anaemia , 2.obstruction to blood flow-giving rise to stenotic and regurgitation murmurs, 3.embolic manifestations-in central nervous system or in visceral systems and in limbs [2],[3],[4]. In our patient left ventricular tumoral mass manifested with systemic embolization resulting splenic infarction, bilateral renal infarctions and paraplegia due to abdominal aortic obstruction at bifurcation. Hence is the interest in presentation of this case report.

References

1Murphy JG, Freeman WK. Neoplastic heart disease. In Murphy JG ed. Mayo clinic cardiology review, 2nd ed. Philadelphia: Lippincot WilliamandWilkins, 2000:1139- 1140.
2Roberts WC. Cardiac neoplasms. In Topol EJ ed.Text book of cardiovascular medicine, 2nd ed. Philadelphia: Lippincot Williams and Wilkins, 2002: 921-933.
3Gurlertop Y, Yilmaz M, Erdogan F, Acikel M, Kose N. Left ventricular outflow tract myxoma. Eur J Echocardiogr 2003;1(1):339-341.
4Kawano H, Tayama K, Akasu K, Komesu I, Fukunaga S, Aoyagi S. Left ventricular myxoma: report of a case. Surg Today 2000;30(12): 1112-1114.