Navigating Cardiac Myxomas: A Compelling Case of a Giant Atrial Myxoma With Embolic Complications

Cardiac myxomas are the most common primary cardiac tumors, predominantly affecting the left atrium and often seen in women aged 30-60. They can present diagnostic and therapeutic challenges, especially in atypical demographics. If left untreated, myxomas can lead to severe morbidity due to embolic events and intracardiac obstruction. Herein, we describe a rare presentation of an exceptionally large left atrial myxoma, emphasizing the clinical, diagnostic, and surgical considerations required to manage such complex cases effectively. A 61-year-old man with a history of poorly controlled hypertension and hyperlipidemia presented with dyspnea, lower extremity edema, and syncope, as an acute manifestation and was found to have a large, mobile mass measuring 9.5 × 4.5 cm in the left atrium, intermittently prolapsing into the mitral valve orifice during diastole on transthoracic echocardiography, with a provisional diagnosis of myxoma. Additionally, a chest computed tomography scan revealed a subsegmental pulmonary embolus, with the left-sided myxoma being the most plausible cause. Given the tumor size and embolic risk, the mass was managed surgically via a median sternotomy approach. Histopathology confirmed a benign cardiac myxoma, characterized by stellate and myxoid cells within a myxomatous stroma. Postoperatively, the patient's symptoms resolved, and a 12-week follow-up echocardiography showed no residual mass. This case underscores the critical importance of considering cardiac myxoma in the differential diagnosis of acute cardiac symptoms, particularly when embolic phenomena are concurrent. The case highlights the necessity for prompt surgical intervention to mitigate the risk of embolic complications and to restore normal hemodynamic function. Despite the benign nature of myxomas, their potential for severe complications necessitates a high index of suspicion and timely intervention.