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| {{DiseaseDisorder infobox |
| | '''For patient information click [[Atrial myxoma (patient information)|here]]''' |
| Name = Myxoma |
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| ICD10 = {{ICD10|D|15|1|d|10}} |
| | {{Infobox_Disease | |
| ICD9 = {{ICD9|212.7}} | | | Name = Cardiac Myxoma | |
| ICDO = 8840/0 |
| | Image = Cardiac-myxoma.jpg | |
| Image = Myxoma chest x-ray 1.jpg| | | Caption = CT scan of Left Atrial Myxoma<ref name=zzz>Image courtesy of Radswiki [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/cardiac-myxoma ''here'']).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref> | |
| Caption = Lateral chest radiograph from a 16-year-old girl with syncope and bacterial endocarditis. The radiograph demonstrates two areas of dense calcification (arrowheads) overlying the posterior aspect of heart. The posterior-anterior (PA) view confirmed location in the heart (not shown). At surgery a calcified myxoma of the right atrium was removed. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>| | |
| OMIM = 255960 |
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| OMIM_mult = |
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| MedlinePlus = |
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| eMedicineSubj = med |
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| eMedicineTopic = 186 |
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| DiseasesDB = 30736 |
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| MeshID = D009232 |
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| }} | | }} |
| {{SI}} | | {{Myxoma}} |
| {{WikiDoc Cardiology Network Infobox}} | | {{CMG}}; {{AE}} {{S.G.}} {{MV}}{{CZ}} {{AAM}} |
| {{CMG}} | |
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| '''Associate Editor-In-Chief:''' {{CZ}}
| | {{SK}}Atrial myxoma; Intracardiac myxoma; Cardiac myxoma; Myxoma of the heart; Heart myxoma; Left atrial myxoma; Right atrial myxoma |
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| {{Editor Help}}
| | ==[[Myxoma overview|Overview]]== |
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| ==Overview== | | ==[[Myxoma historical perspective|Historical Perspective]]== |
| A '''myxoma''' (''Myxo-'' = Latin for [[mucus]]) is the most common primary [[tumor]] of the [[heart]]. Myxomas are usually located in either the [[left atrium|left]] or [[right atrium]] of the heart; about 86 percent occur in the [[left atrium]].<ref>Knepper LE, Biller J, Adams HP Jr, Bruno A. Neurologic manifestations of atrial myxoma. A 12-year experience and review. Stroke. 1988 Nov;19(11):1435-40. ([http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3188128 Medline abstract])</ref>
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| Myxomas are typically [[peduncle (anatomy)|pedunculate]]d, with a stalk that is attached to the [[interatrial septum]]. The most common location for attachment of the stalk is the [[fossa ovalis]] region of the interatrial septum.
| | ==[[Myxoma classification|Classification]]== |
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| The phrase "myxomatous degeneration" refers to the process in which [[connective tissue]] becomes filled with [[mucus]].
| | ==[[Myxoma pathophysiology|Pathophysiology]]== |
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| About 71% of myxomas occur in the heart, 41% on the skin, and 7% in the oral cavity (usually on the palate).
| | ==[[Myxoma causes|Causes]]== |
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| == Diagnosis == | | ==[[Myxoma differential diagnosis|Differentiating Myxoma from other Diseases]]== |
| It is most seen on [[echocardiography]], as a pedunculated mass that is heterogeneous in appearance.
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| The [[differential diagnosis]] include other cardiac tumors such as [[lipoma]]s and [[rhabdomyoma]]s. These other tumors of the heart are typically not pedunculated, however, and are more likely to infiltrate the muscle of the heart. Cardiac Magnetic resonance Imaging can help non-invasively diagnose cardiac tumors.
| | ==[[Myxoma epidemiology and demographics|Epidemiology and Demographics]]== |
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| == Symptoms == | | ==[[Myxoma risk factors|Risk Factors]]== |
| Symptoms associated with cardiac myxomas are typically due to the effect of the mass of the tumor obstructing the normal flow of blood within the chambers of the heart.
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| Some symptoms of myxoma may be associated with the release of [[interleukin 6]] (IL-6) by the myxoma.<ref name="Seino-IL6">{{cite journal | author=Seino Y, Ikeda U, Shimada K. | title=Increased expression of interleukin 6 mRNA in cardiac myxomas. | journal=Br Heart J | year=1993 | volume=69 | issue=6 | pages=565-7 | id=PMID 8343326}}</ref><ref name="Jourdan-IL6">{{cite journal | author=Jourdan M, Bataille R, Seguin J, Zhang XG, Chaptal PA, Klein B | title=Constitutive production of interleukin-6 and immunologic features in cardiac myxomas.| journal=Arthritis Rheum | year=1990 | volume=33 | issue=3 | pages=398-402 | id=PMID 1690543}}</ref> High levels of IL-6 may be associated with a higher risk of embolism of the myxoma.<ref name="Wada-IL6">{{cite journal | author=Wada A, Kanda t, Hayashi R, et al. | title=Cardiac myxoma metastasized to the brain: potential role of endogenous interleukin-6. | Journal=Cardiology | year=1993 | volume=83 | issue=3 | pages=208-11 | id=PMID 8281536}}</ref>
| | ==[[Myxoma natural history|Natural History, Complications and Prognosis]]== |
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| Symptoms of a cardiac myxoma include<ref name="Fisher-Cardiacmyxoma">{{cite journal | author=Fisher J. | title=Cardiac myxoma. | journal=Cardiovasc Rev Rep | year=1983 | issue=4 | pages=1195-9}}</ref>:
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| * [[Dyspnea]] on exertion
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| * [[Fever]]
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| * [[Weight loss]]
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| * Lightheadedness or [[syncope]] (Loss of consciousness)
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| * [[Hemoptysis]]
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| * [[Sudden death]]
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| ==Diagnosis== | | ==Diagnosis== |
| | [[Myxoma staging|Staging]] | [[Myxoma history and symptoms|History and Symptoms]] | [[Myxoma physical examination|Physical Examination]] | [[Myxoma laboratory tests|Laboratory Findings]] | [[Myxoma electrocardiogram|Electrocardiogram]] | [[Myxoma chest x ray|Chest X Ray]] | [[Myxoma CT|CT]] | [[Myxoma MRI|MRI]] | [[Myxoma echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Myxoma other imaging findings|Other Imaging Findings]] | [[Myxoma other diagnostic studies|Other Diagnostic Studies]] |
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| ===Chest x-ray=== | | ==Treatment== |
| <div align="left">
| | [[Myxoma medical therapy|Medical Therapy]] | [[Myxoma surgery|Surgery]] | [[Myxoma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Myxoma future or investigational therapies|Future or Investigational Therapies]] |
| <gallery heights="225" widths="225">
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| Image:Myxoma chest x-ray 1.jpg|Lateral chest radiograph from a 16-year-old girl with syncope and bacterial endocarditis. The radiograph demonstrates two areas of dense calcification (arrowheads) overlying the posterior aspect of heart. The posterior-anterior (PA) view confirmed location in the heart (not shown). At surgery a calcified myxoma of the right atrium was removed. </small>[http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]</small>
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| </gallery>
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| </div>
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| ===Echocardiography===
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| <gallery heights="175" widths="175">
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| Image:Myxoma.jpg|Left Atrial Myxoma (M Mode echo)
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| Image:Myxoma echo 1.jpg|Transthoracic echocardiogram (short axis, parasternal view) through the level of the atria shows a round, echogenic mass (arrowhead) within the left atrium attached to the atrial septum. The patient was a 44-year-old woman with chest pain and left atrial myxoma. AO = aorta; RA = right atrium; RV = right ventricle. </small>[http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]</small>
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| </gallery>
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| </div>
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| ===Cardiac CT===
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Atrial-myxoma-01.jpg|CT demonstrate a cardiac myxoma in the left atrium <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Atrial-myxoma-02.jpg|CT demonstrate a cardiac myxoma in the left atrium <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Atrial-myxoma-03.jpg|CT demonstrate a cardiac myxoma in the left atrium <small>Image courtesy of RadsWiki and copylefted</small>
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| </gallery>
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| </div>
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| ===Cardiac MRI===
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| <div align="left">
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| <gallery heights="225" widths="225">
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| Image:Left atrial myxoma MRI 1.jpg|Axial T1-weighted MRI shows a soft tissue mass within the left atrium isointense to skeletal muscle (arrowheads). A friable myxoma was removed from the left atrium of a 53-year-old man with cerebrovascular accidents.
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| </gallery>
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| </div>
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| ===Gross Pathological Findings===
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| [http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| <gallery heights="225" widths="225">
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| Image:Atrial myxoma 1.jpg|A gelatinous tumor is attached by a narrow pedicle to the atrial septum. The myxoma has an irregular surface and nearly fills the left atrium.
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| Image:Left atrial myxoma 1.jpg|Left Atrial Myxoma
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| </gallery>
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| </div>
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| <gallery heights="225" widths="225">
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| Image:Atrial myxoma aorto iliac emboli 1.jpg|Myxoma Embolus to Iliac Bifurcation: An embolized fragment of the tumor
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| Image:Cardiac tumor 3.jpg|Atrial Myxoma: A calcified right atrial mass on the X ray of a 47-year-old man. Resection demonstrated a smooth-surfaced tumor. The gritty material seen microscopically on cut section was calcified and ossified myxoma.
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| </gallery>
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| </div>
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| <gallery heights="225" widths="225">
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| Image:Large left atrial myxoma 1.jpg|Myxoma: Gross natural color (outstanding) photo of intact large left atrial myxoma with atrium and left ventricle opened in usual way
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| </gallery>
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| </div>
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| ===Histological Findings===
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| [http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| <gallery heights="225" widths="225">
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| Image:Cardiac myxoma mic 1.jpg|Cardiac myxoma with ossification: Note central area of bone surrounded by myxoma.
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| Image:Cardiac myxoma mic 2.jpg|Cardiac Myxoma: Gamna Bodies: A peculiar form of fibrosis with deposition of iron pigment, identical to that seen in the spleens of patients with sickle cell anemia, is not uncommon in myxoma.
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| </gallery>
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| </div>
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| <gallery heights="225" widths="225">
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| Image:Cardiac myxoma mic 3.jpg|Cardiac Myxoma Common features at the interface with the atrial septum include lymphoid aggregates, smooth muscle bundles, and thick walled vessels which angiographically may look like neovascularization.
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| Image:Cardiac myxoma mic 4.jpg|Cardiac Myxoma The extramedullary hematopoiesis seen here is present in about 7 percent of cardiac myxomas.
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| </gallery>
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| </div>
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| <gallery heights="225" widths="225">
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| Image:Cardiac myxoma mic 5.jpg|Cardiac Myxoma Glandular structures are seen in less than 5 percent of cases. In this example, they were limited to the base of the myxoma
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| Image:Cardiac myxoma mic 6.jpg|Cardiac Myxoma In this myxoma, glandular structures compose the majority of the lesion. Typical myxoma nests merge imperceptibly with glands. The differential diagnosis includes metastatic carcinoma; however, atypia and mitoses are absent.
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| </gallery>
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| </div>
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| ==Videos==
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| ===Right atrial myxoma===
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| <googlevideo>-1570842460577936764&hl=en</googlevideo>
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| <googlevideo>3839990493499607408&hl=en</googlevideo>
| | ==Case Studies== |
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| == Treatment ==
| | [[Myxoma case study one|Case #1]] |
| Myxomas are usually removed surgically. The surgeon removes the myxoma, along with at least 5 surrounding milimeters of atrial septum. He or she will then repair the septum using material from the pericardium.
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| == See also == | | == See also == |
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|1}} |
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| == External links ==
| | {{WikiDoc Help Menu}} |
| * {{GPnotebook|-435814399}}
| | {{WikiDoc Sources}} |
| * {{MerckHome|03|031|b}}
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| == Acknowledgements ==
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| The content on this page was first contributed by: [[C. Michael Gibson]] M.S., M.D.
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