Embolic complications of cardiac myxomas: A case report of acute ischemia in a young woman

Introduction and importance

Primary cardiac tumors are rare with myxomas representing about 50 % of benign types, typically arising sporadically in adults aged 30-60 and predominantly in the left atrium. Symptoms result from obstruction, embolization or arrhythmias. Embolic complications, particularly in young patients without cardiovascular risk factors, should raise suspicion of an intracardiac tumor. Prompt recognition and management are critical to prevent serious outcomes.

Case presentation

A 24-year-old woman presented with sudden bilateral lower limb paralysis and ischemic pain. Clinical evaluation revealed absent pulses and sensory-motor deficits in both legs. CTA demonstrated thrombotic occlusion at the aortic bifurcation and major arteries of both lower limbs, as well as signs of renal and splenic ischemia. Emergency embolectomy was performed using a Fogarty catheter and histopathology of embolic material revealed a cardiac myxoma. On postoperative day 0, reperfusion syndrome developed in the right leg necessitating fasciotomy. Echocardiography identified a left atrial mass which was surgically excised. The patient recovered with residual right peroneal nerve palsy and was referred for rehabilitation.

Clinical discussion

In young patients with embolic events and no prior cardiac disease, intracardiac tumors must be considered. Echocardiography is the diagnostic modality of choice, supported by CT/MRI when needed. Surgical resection is curative, but complications such as reperfusion syndrome can arise. Long-term follow-up with annual echocardiography is recommended due to recurrence risk.

Conclusion

This case illustrates the importance of early diagnosis, multidisciplinary intervention and coordinated care in achieving favorable outcomes in patients with cardiac myxoma presenting with acute embolic events.