Cardiac myxoma misdiagnosed as infective endocarditis: a case of Carney complex
Chang Hun Kim1, Hyung Gon Je2, Min Ho Ju1
1Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Republic of Korea.
Insights
Infective endocarditis and cardiac myxoma share symptoms, leading to misdiagnosis. A young patient with stroke and a cardiac mass was diagnosed with Carney complex, highlighting its importance in differential diagnosis.
Area of Science:
- Cardiology
- Genetics
- Endocrinology
Background:
- Infective endocarditis and cardiac myxoma present with overlapping symptoms like fever, embolism, and intra-cardiac masses, often leading to misdiagnosis.
- This case highlights the diagnostic challenges in differentiating these conditions, even with advanced imaging techniques.
Observation:
- A 24-year-old male with a history of Cushing syndrome presented with recurrent fever and stroke.
- A mobile mass was detected in the left atrium, initially suspected as infective endocarditis.
- Intraoperative echocardiography revealed a 7 cm mass on the interatrial septum, which was surgically excised and confirmed as myxoma.
Findings:
- Pathological examination confirmed cardiac myxoma.
- Genetic analysis and clinical presentation led to the diagnosis of Carney complex.
- The patient's presentation mimicked infective endocarditis due to shared clinical features.
Implications:
- Carney complex should be considered in the differential diagnosis of infective endocarditis, especially in young patients with embolic stroke and a history of endocrine neoplasia.
- Early and accurate diagnosis of Carney complex is crucial for appropriate management and to prevent complications associated with cardiac myxoma and other endocrine abnormalities.
Background:
Infective endocarditis and cardiac myxoma have common features including fever, systemic embolism and intra-cardiac masses. For this reason, these diseases are often misdiagnosed one for another despite proper imaging studies. Herein, we report a case of suspected infective endocarditis in a patient with acute stroke, fever and a mass adjacent to the mitral valve.
Case Presentation:
A 24-year-old male patient presented with recurrent fever and stroke. In view of a history of Cushing syndrome and a mobile mass in the left atrium, infective endocarditis was highly suspected. He was transferred for emergency cardiac surgical intervention. During surgery, intraoperative transesophageal echocardiography revealed a 7 cm mass attached to the interatrial septum. The mass was excised through right mini-thoracotomy and pathological examination confirmed the presence of a myxoma. Based on the above clinical findings and genetic analysis, the diagnosis of Carney complex was confirmed.
Conclusions:
Infective endocarditis and cardiac myxoma have common features and can be misdiagnosed. If a young patient presenting with embolic stroke had a history of an endocrine neoplasm, Carney complex should be considered in the differential diagnosis of infective endocarditis.
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