Cardiac Myxoma With Gamna-Gandy Bodies in a Nicaraguan Patient: Leveraging Advanced Imaging to Reduce Mortality Risk

Myxomas are the most frequent primary cardiac neoplasms, presenting with diverse clinical manifestations depending on their size and location due to obstructive effects on blood flow. In patients with pre-existing structural heart disease, their nonspecific symptoms can closely mimic acute heart failure, valvular disease, or even pulmonary thromboembolism, leading to significant diagnostic challenges. We describe the case of a 59-year-old Hispanic male patient with hypertensive heart disease with preserved ejection fraction and paroxysmal atrial fibrillation, poorly adherent to treatment. He initially presented to a primary care facility with progressive exertional dyspnea, raising suspicion of pulmonary embolism and prompting referral to our tertiary center. However, transthoracic and transesophageal echocardiography, computed tomography, and cardiac magnetic resonance imaging revealed a left atrial mass, establishing a presumptive diagnosis of a cardiac myxoma and excluding alternative pathologies. Histopathological analysis confirmed the diagnosis and revealed the presence of Gamna-Gandy bodies within the myxoma, characterized by hemosiderin deposition, fibrosis, and calcifications indicative of chronic microhemorrhages. These findings suggest prolonged vascular congestion and recurrent hemorrhages, potentially increasing the tumor's friability and embolic risk. Without surgical resection, the patient would have faced a high risk of systemic embolism, including stroke, acute limb ischemia, or mesenteric infarction, as well as potential sudden cardiac death due to mitral valve obstruction. Early identification of the myxoma facilitated timely surgery, which was successfully performed, preventing these life-threatening complications. This case highlights the critical role of advanced imaging in differentiating cardiac myxomas from other conditions, enabling prompt surgical intervention and improving prognosis, particularly in resource-limited settings.