Clinical value of imaging for diagnosis of left atrial myxoma neurological complications

Objective: Neurologic complications may be the first symptoms of atrial myxomas. In this paper, we try to identify neuroimaging features for patients with neurologic complications attributed to atrial myxoma through a retrospective analysis to promote the understanding of the disease, and to provide the basis for clinical diagnosis and treatment. Methods: We retrospectively reviewed the medical records of 119 patients with pathologically confirmed atrial myxoma at Xiangya Hospital from January 2009 to March 2015. The neuroimaging data of patients with neurologic complications were analyzed. Results: 13 patients had neuroimaging data, and 8 patients presented with neuroimaging changes. There were 5 cases of cerebral infarctions (62.5%) and 3 cases of aneurysms (37.5%). The main patterns of the infarctions were multiplicity (100.0%), two or more than two vascular areas involved in 4 cases, and one vascular area involved in 1 cases. 2 patients of acute cerebral infarction, and acute and subacute lesions coexisting in 3 patients. The aneurysms were fusiform, multiple and located in the distal middle cerebral artery (100.0%), posterior cerebral artery (66.7%), 2 cases complicated with old cerebral infarction. It was notable that high-density in the vicinity of the aneurysms was observed on CT in 2 patients (66.7%), and homogenous enhancement surrounding the aneurysms was detected in the enhanced imaging in 2 patients (66.7%). All of the 8 patients with atrial myxomas (6.72%) presented with neurologic manifestations, which constituted the initial symptoms in 7 patients (87.5%), while 1 patients (12.5%) presented neurologic symptoms postoperatively. Conclusion: Neurologic complications secondary to atrial myxoma consist of cerebral infarctions and aneurysms, which show certain characteristic features in neuroimaging. The enhancement acquaint of the neuroimaging features with neurologic complications attributed to atrial myxoma, is likely to contribute to a significant decrease in the missed diagnosis and misdiagnosis of left atrial myxoma. (authors)