Right atrial myxoma as a possible cause of hemorrhagic stroke and sudden death
A 50-year-old man presented for the first time at the accident and emergency department of our hospital with an hour's history of headache and subsequent loss of consciousness. Examination revealed a middle-aged man who was unconscious with a Glasgow coma score of 7/15. His blood pressure was 190/130 mmHg and his pulse rate was 86 beats per min. The first and second heart sounds were normal and no murmurs were heard on auscultation. The patient was tachypneic and had a respiratory rate of 40 cycles/min. Fine crepitations were heard in both lung fields. The intra-abdominal organs were not palpably enlarged.\nAn assessment of cerebrovascular disease was made. He was subsequently admitted into the accident and emergency unit and appropriate treatment instituted. He, however, died about 6 h after presentation.\nAt autopsy, the patient's heart weighed about 600 g. The left ventricular free wall thickness was 1.5 cm. The right ventricle was flabby and hypertrophic with a right ventricular free wall thickness of 1.1 cm. The tricuspid valve ring circumference measured 12.6 cm while the pulmonary valve ring measured 7.2 cm. An interventricular septal defect measuring 4.5×1.5 cm was seen in the posterior portion of the muscular septum.\nWithin the right atrium, there was a globular, multinodular mass filling the entire right atrial cavity and attached to its posterolateral wall by a short stalk. The mass measured 9.2×7.5.0×4.0 cm []. The external surface of the mass was smooth and grayish-white in color while the cut surfaces revealed grayish-white tissue with a gelatinous consistency. A large thrombus measuring 2×2×2 cm was seen firmly adherent to the tip of the mass. The coronary and pulmonary arteries were all normal.\nThe brain weighed 1400 g. There was a localized, well-circumscribed intraparenchymal hemorrhage within the superior left temporal lobe. The hemorrhagic area measured 1.2× 1.0×0.8 cm. There was no evidence of brain herniation or injury to the brain stem.\nThe liver was mildly enlarged and showed fatty change while the kidneys showed macro- and micro-scopic evidence of benign nephrosclerosis.\nMicroscopically, sections from the globular mass showed typical round to polygonal myxoma cells with abundant cytoplasm dispersed in a markedly loose amorphous myxoid extracellular matrix []. Focal areas of calcification and hemorrhage were seen within the mass.