Cardiac Myxoma: Cortical Hypointense and Micro-aneurysmal Lesions

Cardiac myxomas are primary heart tumors that, while biologically benign, can lead to severe systemic complications. Recent clinical reports, including a case detailed in Cureus, highlight the potential for these tumors to cause neurological manifestations, such as cortical hypointense lesions and micro-aneurysmal lesions in the brain.

Although these tumors do not spread like malignant cancers, they are often described as functionally malignant due to their tendency to embolize. This means fragments of the tumor or associated blood clots can break away and travel through the bloodstream to other organs, including the brain.

Characteristics and Prevalence of Cardiac Myxomas

Cardiac myxomas are the second most common benign primary cardiac tumors, following papillary fibroelastoma. They can occur sporadically or as part of a familial condition known as Carney complex disorder.

While these tumors can affect individuals of any age, they most frequently manifest between the third and sixth decades of life, with a mean age of diagnosis of 50 years. There is a slight preponderance in females, with a ratio of 2:1.

In children, cardiac myxomas are commonly diagnosed around a mean age of 9 to 10 years. They are, however, incredibly uncommon in newborns and fetuses.

Location and Physical Presentation

Approximately 90% of cardiac myxomas originate in the atrium, typically appearing as a solitary or pedunculated mass. Within the atrial chambers, 75% of these tumors occur in the left atrium, specifically close to the fossa ovalis.

Other possible locations include the right atrium, the ventricles, and the heart valves. The tumors may present in two morphological forms: papillary and polypoid.

Neurological and Systemic Complications

The most significant risks associated with cardiac myxomas involve intracardiac obstruction and the formation of emboli. When these emboli travel to the brain, they can cause a variety of neurological manifestations.

• Ischemic strokes
• Myxomatous aneurysms
• Metastases
• Multiple cortical hypointense lesions
• Micro-aneurysmal lesions

Diagnostic imaging plays a critical role in identifying these complications. T2*-weighted imaging has been used to reveal multiple cortical hypointense lesions in patients with cardiac myxoma. Brain MRI and angiography have shown homogeneously enhanced aneurysms featuring a hypointensity rim on T2-weighted images.

Beyond neurological issues, cardiac myxomas can cause constitutional symptoms that mimic inflammatory diseases or connective tissue disorders. These complications can arise even if the patient does not initially exhibit symptoms.

Diagnosis and Treatment

There is no pathognomonic clinical presentation for cardiac myxoma, meaning there is no single set of symptoms that definitively identifies the condition. In some cases, such as during pregnancy, the tumors may be diagnosed for the first time via echocardiography.

The primary treatment for cardiac myxoma is complete surgical excision of the tumor. This may involve the use of robotic surgery to ensure the mass is fully removed.

Following surgery, long-term follow-up is necessary to monitor for tumor recurrence. This is typically achieved through interval echocardiography.

For pregnant patients, surgical management of cardiac myxomas has been reported to result in favorable maternal and foeto-neonatal outcomes, as noted in a review of 51 patients across 44 articles.