Missed diagnosis of cardiac myxoma and the subsequent complications despite therapeutic anticoagulation: a case report

INTRODUCTION: Myxomas are the most prevalent primary cardiac tumors, primarily found in the left atrium. Symptoms include mitral valve obstruction and systemic embolization, leading to complications like ischemic stroke. Accurate diagnosis through cardiac evaluation is crucial to prevent delays in treatment and recurrence of symptoms. CASE PRESENTATION: A 53-year-old male patient with a history of an acute stroke three months prior and an incomplete workup presented with right-sided hemiplegia and dysarthria. A diagnosis of acute stroke was made, and the patient was managed with mechanical thrombectomy, retrieving a large clot in the Middle Cerebral Artery (MCA) territory. Cardiac workup revealed a large mobile mass in the left atrium, and a diagnosis of myxoma was made. The tumor was removed successfully via thoracotomy. The patient remained asymptomatic without any residual mass. CONCLUSION: While cardiac myxomas are primarily benign tumors, they can occasionally lead to catastrophic complications. A comprehensive cardiac evaluation, including Transthoracic Echocardiography (TTE), is essential in stroke cases where a cardioembolic source is suspected to identify the underlying pathology. Our case highlights how omission of TTE during the index admission resulted in recurrent stroke despite anticoagulation and underscores the preventable nature of such complications through routine cardiac imaging in suspected cardioembolic events.