A probable case of right atrial myxoma presenting with features of restrictive cardiomyopathy

Abstract

Cardiac tumors are very rare and most frequently benign. Myxomas are the most common primary cardiac tumors accounting for about 50% of cases. The clinical presentation of atrial
myxomas depends on size, anatomical location and their effects on the surrounding structures rather than the histological type. Restrictive cardiomyopathy can present with features of heart failure with typical massive ascites out of proportion to peripheral oedema known as egg on stick appearance. We present a case of a probable right atrial myxoma in a 20year old lady mimicking restrictive cardiomyopathy. Case report: Mrs. HD, a 20-year old Fulani lady was referred to us with 3 years history of progressive abdominal swelling, dyspnea on exertion and easy fatiguability. No orthopnea, paroxysmal nocturnal dyspnea, chest pain, palpitation or syncope. Relevant examination findings include a chronically ill looking young lady, with egg on stick appearance and mild pitting pedal edema. She had tachycardia, blood pressure 90/70mmHg & elevated Jugular venous pressure. The liver was palpable about 4cm below the right costal margin and there was massive ascites demonstrable by fluid thrill. Trans- thoracic echocardiography revealed huge, well-defined right atrial mass measuring 64 x 35 x 56.8 mm attached to the superior wall of the atrium on apical four chamber view. Conclusion:Atrial mass should be considered in the differential diagnosis of a patient presenting with features of restrictive cardiomyopathy. Echocardiography and histology are required for definitive diagnosis.