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MYXOMA

MYXOMA. PH SONNEKUS . LECTURE OUTCOMES. Case discussions 1-3 Definition Histology Macroscopic appearance Clinical presentation Diagnosis Management Prognosis. CASE 1. 61 yr male from Petrusburg Referred to internal medicine Pelonomi from orthopaedic ward

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MYXOMA

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  1. MYXOMA PH SONNEKUS

  2. LECTURE OUTCOMES • Case discussions 1-3 • Definition • Histology • Macroscopic appearance • Clinical presentation • Diagnosis • Management • Prognosis

  3. CASE 1 • 61 yr male from Petrusburg • Referred to internal medicine Pelonomi from orthopaedic ward • Conservative Rx for a left pubic rami fracture • Workup for surgery: heartsonar revealed a mobile mass in the right atrium

  4. CASE 1 • Medical Hx: • Hypertension • Current treatment • Ridaq and Renitec • Allergies: • none • Previous surgery: • none • Hospital admissions: • none

  5. CASE 1 • Systemic history: • CVS: • No ortopnoea or PND • Dyspnoea NYHA gr 2 • No palipations • No oedema • Atypical chestpain-associated with heartburn • CNS: • vague history of syncope • RESP: • no complains • ABD: • no comlpains

  6. CASE 1 • On Examination: • Vitals: • BP 170/100 mmHg • HR: 82 bpm, regular and strong • Sats: 98% • No fever • General: • no anaemia, oedema or cyanosis

  7. CASE 1 • On examination: • CVS: • No Sx of fluid overload • Pulses felt • Apex normal 5th ICS MCL • S1 and S2 normal • No murmers • All other systems normal

  8. CASE 1 • Spesial investigations: • Heartsonar: • mobile mass in the right atria • (?Thrombus/vegitation/myxoma) • ECG: • Left ventrucular hypertophy

  9. CASE 2 • 62 yr Female from Winburg • Urology, December 2009 with c/o hematuria • Pre-op workup for TURBT • Presenting complaint: syncope and decreased effort tolerance

  10. CASE 2 • Previous Medical History: • Hypertension, COPD, Ulserativecollitis, Papillary bladder tumour • Social: • 90 pack year smoking history • Current treatment: • Adalat XL, Enalapril, Inflammide and Asthavent inhalers • Allergy: • Penicillin, Sulphas, Aspirin, Elastoplast • Previous Surgery: • Appendisectomy, TURBT, Cholycystectomy, Hiatus hernia repair

  11. CASE 2 • On Examination • Vitals • BP 125/62mmHg • HR: 78 bpm, regular and strong • Temp: 36.2 • No Sx of anaemia, cyanosis or oedema

  12. CASE 2 • On examination: • CVS: • All peripheral pulses palpalble • No sx of fluid overload • Apex not diplaced • S1 and S2 normal • No murmers

  13. CASE 2 • Special investigations • MRI: • LA mass 2 x 1.7 cm • CXR • TEE

  14. Pre op CXR

  15. Pre op MRI

  16. SPECIAL INVESTIGATIONS • Heartsonar: • Mass in left atrium • Angiogram: • Significant stenosis of 80% on circumflex artery • Intermediate lesion on LAD

  17. Cardiothoracic Surgery:Excision myxoma

  18. Myxoma

  19. Myxoma

  20. Myxoma

  21. CASE 3 • 56 yr female from Phuthaditjana • Presenting Complaint: Dyspnoea NYHA gr 2 and atypical chest pain

  22. CASE 3 • Previous Medical History: • Hypertension • Current treatment: • Pharmapress, Ridaq, Adalat XL, Slow K • Previous surgery: • none • Allergies: • None • Other: • Jehova’s witness

  23. CASE 3 • On examination • Vitals: • BP 117/92mmHg • HR 90 bpm, irregular-irregular • Sats: 97% • General: • no oedema, anaemia, cyanosis

  24. CASE 3 • On examination • CVS : • all peripheral pulses palpable • JVP raised • Apex 5th ICS AAL • S1 , S2 no S3 • Tricuspid incompetence 2/6 • RESP • no abnormalities • GIT • no abnormalities

  25. SPECIAL INVESTIGATIONS • Heartsonar: • mass in right atrium Pulmonary hypertention • ECG: • Slow atrial fibrilation

  26. Cardiothoracic Surgery:Excision myxoma

  27. DISCUSSION

  28. INTRODUCTION • Adults • >75% of primary cardiac tumors are benign • Majority of benign lesions are myxomas

  29. CARNEY COMPLEX • Inherited, outosomal dominant disorder • Consists of the following: • Cardiac and mucocutaneous myxomas • Lentiginosis • Endocrine dysfunction (Bilateral adrenal micronodular hyperplasia- may lead to Cushing’s syndrome)

  30. DEFINITION • Myxo = new Latin from Greek word Muxa for mucos • A tumor of primitive connective tissue, filled with mucos

  31. HISTOLOGY • Scattered cells with a mucopolysaccharide stroma. • Cells originate from a multipotent mesenchyme capable of neural and endothelial differentiation • Produce vascular endothelial growth factor • Angiogenisis and early stages of tumor growth

  32. MACROSCOPIC APPEARANCE • Pendunculated • Gelatinous in consistancy • Surface: smooth, villous or friable • Vary wildly in size, ranging from 1-15cm in diameter • Weight anything from 15-189g

  33. CLINICAL MANIFESTATIONS • Cardiovascular manifestations depend upon anatomic location. • +/- 80% of myxomas originate in left atrium, remainder are found in the right atrium.

  34. LEFT ATRIAL MYXOMA

  35. LEFT ATRIUM • Grow into atrial lumen and cause symptoms of obstructing bloodflow or creating mitral regurgitation. • May simulate mitral valve disease • Produce heartfailure • Pulmonary hypertention

  36. LEFT ATRIUM

  37. LEFT ATRIUM • Symptoms and signs • Dyspnoea • Ortopnoea • PND • Pulmonary oedema • Cough • Hemoptises • Fatigue

  38. LEFT ATRIUM • Symptoms may worsen with change in position • Force of gravity pulls myxoma into the opening of mitral valve • Thrombo-embolic phenomena • Release tumour fragments or thrombi into systemic circulation. • Manifests as neurological or vascular symptoms

  39. RIGHT ATRIAL MYXOMA

  40. RIGHT ATRIUM • Pathology and haemodynamic implications: • Grow into atrial lumen • obstruct bloodflow • hemodynamic changes similar to tricuspid stenoses. • Thrombo-emobolic phenomena • Tumour fragments released into pulmonary circulation • Presents similar to pulmonary emboli.

  41. RIGHT ATRIUM • Symptoms and signs • Fatigue • Peripheral oedema • Hepatomegaly • Ascitis • Prominent a waves • +/- diastolic murmer

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