We describe the case of an 83-year-old patient, without significant cardiovascular comorbidities, who presented to the emergency room complaining of acute dysarthria and left facial hemiparesis. Cerebral angio-CT and MRI revealed an ischemic lesion in the right middle cerebral artery. Echo-doppler of carotid arteries was unremarkable. Cardiac rhythm monitoring did not show any abnormalities. Transthoracic and later trans-esophageal echocardiography revealed a large, floating mass in the left atrium of unknown origin, highly suspicious for neoplasia and most likely responsible for the cardio-embolic stroke (Figures 1-4). The mass was considered highly suspicious for neoplasia because the dimensions of the mass didn’t change at all after 5 days of full intravenous anticoagulation. After a multidisciplinary board meeting, the patient was advised to undergo cardiac surgery. Therefore, the atrial mass was surgically resected and the interatrial septum was reconstructed with heterologous bovine pericardial patch, without perioperative or postoperative complications (Figures 5,6). The histopathological analysis revealed cardiac myxoma, with proliferation of polygonal cells, which formed cords around the vessels, with stroma of myxoid aspect (Figures 7-9). The patient could fully recover without neurological sequelae and was discharged home. The follow-up was regular. The patient did not show any recurrent embolic event and echocardiography showed normal left and right ventricular function, without valvulopathies and without signs of recurrences for myxoma. We report this case because the manifestation of the atrial myxoma was not completely typical. The localization, adhered to the atrial septum, was typical, but the multilobate aspect and the age of the first clinical manifestation are quite uncommon. The main differential diagnosis was thrombotic mass [1-4].

The ischemic stroke that occurred, the absence of changes in the dimensions of the mass under anticoagulant therapy, together with the patient’s good general conditions, supported the interdisciplinary decision to proceed to surgical excision, which allowed to reach the final diagnosis.

STATEMENTS

Acknowledgement: We would like to acknowledge Prof Giovanni Pedrazzini, Dr. Priska Gaffuri and Dr. Tiziano Torre for their support in the preparation of this case report and of the images/pictures.

Ethics Statement: Written informed consent was obtained.