Case of the Month

Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO

July 2013

Next Case of the Month coming August 6 . . .

Cardiac Myxoma Metastasis

Myxoma is a rare benign primary cardiac tumor.
Systemic embolism of myxoma fragments has been described in literature; its incidence is 45%, with involvement of the brain in half of these cases.
Metastatic brain lesions sometimes present earlier than the primary lesion, as in the case presented. These lesions are usually multiple and most commonly located at the gray-white matter junction.
Clinical Presentation: Headache, vertigo, focal seizures, and hemiparesis
Key Diagnostic Features: Intraparenchymal appearing hemorrhagic lesions of various sizes with minimal surrounding edema. Occasionally, strokes.
DDx: Hypertensive vascular disease, cerebral amyloid angiopathy , arteriovenous malformation, multiple cavernous malformations, primary neoplasm (glioblastoma with hemorrhage) , metastatic tumors (eg, melanoma, anaplastic lung carcinoma, thyroid carcinoma, choriocarcinoma), hemorrhagic arterial/venous strokes, trauma
Rx: Surgical removal of left atrium myxoma and radiotherapy for brain metastasis