We report the unusual case of a young man with acute respiratory failure caused by means of a left atrial myxoma.

We report the unusual case of a young man with acute respiratory failure caused by means of a left atrial myxoma. The patient's rapid clinical deterioration and harsh hypoxemia suggested the acute respiratory distress syndrome; however, unexpect physical examination findings and a markedly elevated pulmonary capillary wedge squeezing implied cardiac abnormality. The use of echocardiography as a bedside tool allowed correct, rapid diagnosis.

Left atrial myxoma is a rare on the other hand much heralded tumor of the heart with a reported incidence of 0001 to 003 percent[12] The varied manifestations with which atrial myxoma can near often make its diagnosis difficult, and not rarely it is mistaken for other illnesses. The presentation of atrial myxoma may include obstructive, embolic, and constitutional symptoms, or any combination of these.[3-8] Mitral valvular obstruction is probably the principally common finding and symptoms are usually ready for months or years before atrial myxoma is suspected or diagnosed.[4-7] Although atrial myxoma has been place in patients with sudden cardiac death,[6] acute mitral valvular obstruction is virtually not at any time seen as a consequence of left atrial myxoma.

We instant the case of a 23-year-old man admitted to the hospital with bitter refractory hypoxemia, fever, and chills who was construct to have a left atrial myxoma obstructing his mitral valve. The brief duration and pronounced nature of his symptoms portray a rare manifestation of the obstructive potential of atrial myxomas.

CASE REPORT

The patient was referr for evaluation of acute respiratory failure. He had been well until 5 days prior to arrival when he had exhibited fever, chills, and a nonproductive cough across the following 3 days, myalgias, shortness of breath, and mild hemoptysis had discloseed He had visited a bookish man health center three times before presenting to a hospital extremity department with severe respiratory distress. Initial evaluation revealed a expanse air oxygen saturation of 85 percent and diffuse bilateral alveolar infiltrates forward chest radiograph. Broad-spectrum antibiotic theraphy was begun and the patient was given high-flow oxygen at face mask. His condition continued to deteriorate, ultimately leading to intubation and mechanical ventilation with 100 percent oxygen and positive-end expiratory urgency in order to maintain adequate arterial oxygen saturation. After 24 h the patient was transferred to our institution in critical condition.

The patient had no history of swoon presyncope, chest pain, or prior dyspnea. In addition, there was no history of other cardiac disease, endocrinopathy, or family history of myxoma. At the time of hospital admission, the patient's vital signs were as follows: vital fluid pressure, 110/70 mm Hg; heart rate, 110; sinus tachycardia; mechanical ventilation with a rate of 10; tidal bulk of 1,000 ml and 15 cm [Hsub2]O of positive end-expiratory crushing and temperature of 38.2 [degrees] C His examination was notable for iatrogenic paralysis with curare, diffuse crackles in the couple lung fields, and thin, blood-tinged sputum coming from his endotracheal tube. The precordium was hyperdynamic with a harsh grade 3/6 systolic plaint of mitral regurgitation and a tumultuous diastolic "tumor thunk." There were no diastolic indistinct utterances There were no stigmata of embolic phenomena of endocarditis, no clubbing or cyanosis. Laboratory values included an arterial pH of 745 [PCOsub2] of 40 and [POsub2] of 65 while being ventilated with 100 percent [Osub2] The other laboratory terminates included WBC of 14.5, hemoglobin of 116 erythrocyte sedimentation rate of 115 normal coagulation profile, serum albumin of 18 and otherwise normal serum chemistry comes A pulmonary artery catheter was placed and the following compressings were obtained: right atrium, 17 mm Hg; pulmonary artery, 45/33 mm Hg; pulmonary capillary wedge, 30 mm Hg without V waves or abnormal Y declivity The cardiac output was 63 L/min. The patient's condition continued to deteriorate, requiring norepinephrine and dopamine infusions to maintain a systolic posterity pressure of 100 mm Hg A transesophageal echocardiogram was obtained emergently and revealed a large, mobile left atrial mass prolapsing within the mitral valve into the left ventricle (Fig 1) There were no other masses identified and ends of the remainder of the investigation including assessment of the mitral valve and of left ventricular function, were normal. befitting to the large size of the tumor, a mitral valve gradient could not be estimated from Doppler flow studies. A presumptive diagnosis of left atrial myxoma was made and the patient underwent pressing surgical removal of the mass. At the time of operation, a r gelatinous, bilobed myxoma was identified, attached to the atrial septum at a point adjacent to the mitral annulus. The myxoma was remov via endocardial resection and did not require repair of the atrial septum The patient's intraoperative course was uncomplicated and his immediate postoperative pulmonary capillary wedge hurry was 10 mm Hg. athwart the next 48 h, his pulmonary edema rapidly cleared and a repeated echocardiogram revealed normal cardiac erection and function. He was discharged from the hospital forward the seventh postoperative day.

...