Hoarseness Secondary to Left Atrial...

Hoarseness Secondary to Left Atrial Myxoma (*1)

Left atrial myxomas are benign tumors usually construct serendipitously during investigation of patients suspected of having mitral valve disease. Patients primarily not absent with symptoms secondary to the usual triad of obstructive efficiencys (such as congestive heart failure), embolism (neurologic, extremity), or constitutional tenors (fever, anemia). Although other symptom complexe have been reported, we report the first case of a patient presenting with hoarseness secondary to periodical laryngeal nerve damage caused from tumor growth.

CASE REPORT

A 62-year-old woman instanted to a peripheral hospital complaining of a modern deterioration in her voice in the preceding six month She had a ten-year history of hoarseness. A chest roentgenogram revealed left atrial enlargement consistent with mitral valve disease; however, an echocardiogram showed a large left atrial tumor.

The patient was referr to the Ottawa Heart Institute. An in-depth history taken there bareed no other symptoms. most numerous notably, she suffered no dyspnea, episodes of embolism, or constitutional symptoms. forward physical examination, the physician heard a hardy consistent with a "tumor plop" as well as a brief early diastolic mutter Ear, nose, and throat specialists also examined the patient, and indirect laryngoscopy expos left periodical laryngeal nerve palsy with the left cord lying in the lateral position in succession phonation.

The patient was mildly anemic (hemoglobin value, 110 g/L) with a normal MCV There was a slight elevation of the erythrocyte sedimentation rate (44; normal 0-20 mm/h) An electrocardiogram revealed a left atrial abnormality with right axis deviation and right ventricular hypertrophy and another chest x-ray film demonstrated left atrial prominence (Fig 1) A two-dimensional echocardiogram revealed a pedunculated mass in the left atrium.

A CT scan was performed to assess possible causes of periodical laryngeal pathology. The scan showed that the tumor mass displaced the left pulmonary artery into the aortopulmonary window below the arch of the aorta (Fig 2) Finally, tumor vascularity and a space-occupying lesion in the left atrium appeared onward cardiac catheterization.

In the operating apartment a midline sternum splitting incision expos the heart. Externally, it appeared normal. Cardiopulmonary bypass was established and the tumor approached via a standard left atriotomy incision. An 8 cm pedunculated tumor arose from the fossa ovalis in the left atrium. Surgeon remov the tumor and repaired the small resulting flaw in the atrial septum. The gros and microscopic pathology of the tumor confirmed an atrial myxoma.

Atrial dysrhythmias and urinary retention complicated the patient's postoperative course. However, as well-as; not only-but also; not only-but; not alone-but resolved prior to discharge.

in succession follow-up chest x-ray film, the changes noted before surgery had been corrected. Similarly, forward a repeat CT scan (Fig 3) the left pulmonary artery had mov clearing the aortopulmonary window. The patient improved considerably in the month since her surgery Her voice is almost completely restored. Follow-up laryngoscopic examination showed improved adduction of the left vocal cord during phonation, suggesting resolution of the returning laryngeal nerve palsy.

DISCUSSION

Atrial myxomax are the greatest in quantity common form of primary cardiac tumor, accounting for 50 percent of the benign tumors. [2] They are generally solitary and pedunculated, arising from endothelial or subendocardial reservation cells in the fossa ovalis of the left atrium. [3] Lobular and pale-gray atrial myxomas range in size from 04 to 8 cm although they may extend as polypoid masses filling the entire cardiac chamber. [4]

History and physical examination alone rarely discover myxomas, requiring two-dimensional echocardiography to reveal them. They classically cause symptoms becoming to the clinical triad of obstruction, embolization, and constitutional symptoms. Also, these tumors have been known to mimic other diseases so as polyarteritis nodosa [5] and bacterial endocarditis.

No united has yet described the presentation of hoarseness associated with a left atrial myxoma. Hoarseness does present itself with mitral valve disease with left atrial enlargement.

In our case, we be stirred the tumor caused significant left atrial enlargement, elevating the left mainstem bronchus and the left pulmonary artery into the concavity of the aortic arch. This deviation obliterated the aortopulmonary window forward the CT scan. Further, compression of the left returning laryngeal nerve as it hasps around the arch lateral to the ligamentum arteriosum caused a neuropraxia of the might and subsequent voice hoarseness. The follow-up CT findings are consistent with this hypothesis.

Our opinion differs from Hanson et al, [5] who considered left atrial enlargement singular with left atrial myxomas. Hanson and his research collection suggested that myxomas grow rapidly because there is usually high-grade obstruction. As a come they wrote that the left atrium remains relatively small, with any tumor product usually occurring in less than six month Similarly, Marinissen et al [7] observationed that myxomas must grow rapidly since united of their patients developed a tumor within 14 month of a clear echocardiogram. Other reports allude to growth rates of two to 84 month [7] Our patient, however, probably lay opened the myxoma 120 months prior to presentation. The tumor probably grew intermittently during the ten "quiet" years.