Left Ventricular Myxoma-Caused Recurrent Stroke in a Middle-Aged Woman: A Case Report

Na Wu,1 Yinuo Du,1 Xianzheng Li,2 Liting Hu,1 Huhu Li,1 Aimin Gao,1 Jing Dong,1 Li Liu1 1Department of Cardiology, GenerTec Universal Xi’an Beihuan Hospital, The First Hospital of Xi’an Chanba International Port, Xi’an City, Shaanxi Province, People’s Republic of China; 2Department of Radiology, GenerTec Universal Xi’an Beihuan Hospital, The First Hospital of Xi’an Chanba International Port, Xi’an City, Shaanxi Province, People’s Republic of ChinaCorrespondence: Li Liu, Department of Cardiology, GenerTec Universal Xi’an Beihuan Hospital, The First Hospital of Xi’an Chanba International Port, Xi’an City, Shaanxi Province, People’s Republic of China, Email [email protected]: Ischemic stroke primarily occurs in older adults, with thromboembolism representing the most common underlying etiology. However, rare causes such as left ventricular (LV) myxomas are frequently overlooked.Case Presentation: A 53-year-old Chinese woman presented in Emergency Room with acute right-sided hemiparesis and dysarthria. Initial evaluation suggested a cryptogenic stroke, and she underwent thrombolysis (rt-PA) with subsequent clinical improvement. However, she experienced a recurrent ischemic stroke two weeks later, prompting further investigation. Repeat imaging revealed a 20.3 × 13.4 mm pedunculated LV mass attached to the lateral wall - a finding initially missed on prior echocardiography performed by a junior echocardiographer due to suboptimal image quality conducted on an acutely ill, uncooperative patient. The mass’s morphology was consistent with a myxoma and surgical excision was scheduled, however the patient suffered fatal cardiorespiratory arrest before intervention.Conclusion: LV myxoma is a rare but critical stroke etiology. Echocardiography remains pivotal in identifying cardiac masses. This case highlights the diagnostic challenges posed by LV myxomas and underscores the importance of a comprehensive evaluation by an experienced echocardiologist in embolic stroke, especially in uncooperative patient and with atypical clinical presentation.Keywords: left ventricular myxoma, stroke, echocardiography, embolic event