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Misdiagnosis of a Left Atrial Myxoma in a Patient with Endocarditis, Meningitis, Pneumonia, and Embolic Incident

Anna Marcinkiewicz, Stanisław Ostrowski, Sławomir Jander, Łukasz Chrzanowski, Jarosław D. Kasprzak, Ryszard Jaszewski

(Cardiac Surgery Clinic, Chair of Cardiology and Cardiac Surgery, Military Medical Academy University Teaching Hospital – Central Veterans’ Hospital in Łódź, Medical University in Łódź, Łódź, Poland)

Med Sci Tech 2014; 55:27-30

DOI: 10.12659/MST.890578

Background: Vegetations are usually restricted to a valve. When localized within a mitral valve, they should be differentiated with a thrombus, ruptured chordae tendineae, myxoma, papillary fibroelastoma, or Lambl’s excrescences.
Case Report: We present a case of a 59-year-old female, emergently admitted to a hospital and diagnosed with pneumococcal meningitis. Computed tomography was negative. Chest X-ray revealed bilateral hilar consolidations suggesting inflammation. Physical examination disclosed cardiac systolic murmur. Transthoracic and transesophageal echocardiography revealed a double-pedicled structure with moderately increased echogenicity, arising from the mitral annulus, posterior leaflet, and partially from the atrial wall, causing important mitral regurgitation. A few weeks later, she underwent embolectomy of the left external iliac and femoral arteries due to an acute lower limb ischemia. She was emergently referred to an atrial tumor excision. After the left atrium was opened, inflammation and thickening of the posterior leaflet were found. An empty abscess was discovered near the medial commissura and P1 posterior leaflet segment. The valve culture revealed Enterococcus faecalis.
Conclusions: In most cases, analysis of clinical history and imaging methods results can give final diagnosis. Although echocardiograms suggested a myxoma, the clinical presentation of our patient was more indicative for endocarditis. Invasive pneumococcal infection demands careful cardiac examination because co-infection can complicate the clinical course.

Keywords: vegetation, , meningitis,, myxoma,, pneumonia,, Embolism

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