Abdominal aortic occlusion caused by a cardiac myxoma: a multi-modality imaging approach

<span class="paragraphSection">A 63-year-old previously healthy man presented with sudden onset of bilateral flank pain and legs paraesthesia. Cardiovascular examination revealed a diminished femoral, popliteal and dorsalis pedis pulses while neurological evaluation revealed diffuse paraesthesia and absence of both Achilles and patellar reflexes. In the suspicion of a possible spine injury, a lumbar spine magnetic resonance was obtained. Sagittal T2-images showed a hyperintensive aorta below the celiac trunk (<span style="font-style:italic;">Panel A</span>) while the axial acquisition suggested a thrombotic occlusion of the infrarenal aorta (<span style="font-style:italic;">B</span>). Computed tomography angiography (CTA) confirmed the complete thrombotic occlusion up to the femoral arteries (<span style="font-style:italic;">C</span><span style="font-style:italic;">–</span><span style="font-style:italic;">E, G</span>). Moreover, both splenic and bilateral renal infarctions were detected (<span style="font-style:italic;">F</span><span style="font-style:italic;">–</span><span style="font-style:italic;">G</span>). Conversely, celiac trunk, inferior, and superior mesenteric artery were free from thrombosis. Transthoracic echocardiogaphy, showed a normally contracting left ventricle (with chamber of normal size) and absence of atrial and/or ventricular masses. A cardiovascular surgeon was consulted and an emergency surgery was scheduled to perform a thromboembolectomy. A gelatinous mass was found and removed. Reperfusion of abdominal aorta was confirmed by intraoperative Doppler examination, the plethoric appearance of renal cortex and post-interventional CTA (<span style="font-style:italic;">H</span>). A transoesophageal echocardiogram, performed during the second post-operative day showed absence of atrial or ventricular masses. Moreover, a cardiac magnetic resonance confirmed the absence of cardiac tumours. As result, it was impossible to identify the exact site of origin of the myxoma. Histopathological and immunohistochemical examinations revealed lax connective tissue with stellate myxoma cells characterized by abundant eosinophilic cytoplasm with positive expression for Vimentin and CD 34, suggesting a complete detachment and embolization of a cardiac myxoma. </span>

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