Email this article Heart myxoma under the mask of interstitial lung lesion: a difficult case from practice
- Authors: Novikova A.V.1, Pravdyuk N.G.1, Shostak N.A.1, Galimova N.V.1, Kotova D.P.2, Abeldyaev D.V.1, Aleksanyan G.G.3
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Affiliations:
- Pirogov Russian National Research Medical University, Ministry of Health of Russia
- N.I. Pirogov First City Clinical Hospital, Moscow Health Department
- Federal State Budget Institution A. N. Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation
- Issue: Vol 14, No 3-4 (2020)
- Pages: 69-77
- Section: CASE REPORT
- Published: 26.01.2021
- URL: https://klinitsist.abvpress.ru/Klin/article/view/457
- DOI: https://doi.org/10.17650/1818-8338-2020-14-3-4-K635
- ID: 457
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Abstract
The aim of the investigation was to describe a clinical case of the development of interstitial lung lesions in a 57-year-old man with a large left atrial myxoma, which had a reverse development after myxomectomy.
Materials and methods. Patient V., 57 years old, was hospitalized in the therapeutic department of the City Clinical Hospital No. 1 named after N. I. Pirogov in connection with bilateral polysegmental pneumonia. A month before hospitalization, he underwent an outpatient examination for progressive dyspnea. Myxoma of the heart was diagnosed. Due to the progression of respiratory failure and the appearance of fever, he was hospitalized. Amidst the multistage antibiotic therapy, there was a torpid course of lung pathology with syndromes of bilateral dissemination and “ground glass”, bilateral lymphadenopathy of the mediastinum, high pulmonary hypertension, and systemic inflammatory reaction syndrome. Thromboembolism of the branches of the pulmonary artery, tuberculosis, sepsis, infective endocarditis, neoplastic processes of pulmonary and other localization were excluded.
Results. The clinical picture corresponded to interstitial lung lesions within the framework of paraneoplastic syndrome in heart myxoma. It was decided to urgently carry out myxomectomy.
Conclusion. The clinical case demonstrates the development of a rare variant of paraneoplastic syndrome in left atrial myxoma, which was suspected during the patient’s treatment for bilateral polysegmental pneumonia. The progression of the pulmonary lesion was explained by active interstitial inflammation and was supported by the immunological activity of the heart tumor.
The performed myxomectomy, despite the persisting syndrome of systemic inflammatory reaction and infiltration of the lung tissue, led in 2 weeks to complete resolution of interstitial lung lesions and pulmonary hypertension, which confirmed the causal relationship between myxoma of the heart and involvement in the pathological process of the lungs.
About the authors
A. V. Novikova
Pirogov Russian National Research Medical University, Ministry of Health of Russia
Author for correspondence.
Email: annove2008@mail.ru
ORCID iD: 0000-0002-8104-9791
Department of Faculty Therapy named after Academician A. I. Nesterov
1 Ostrovityanova St., Moscow 117997
Russian FederationN. G. Pravdyuk
Pirogov Russian National Research Medical University, Ministry of Health of Russia
ORCID iD: 0000-0002-9710-699X
Department of Faculty Therapy named after Academician A. I. Nesterov
1 Ostrovityanova St., Moscow 117997
Russian FederationN. A. Shostak
Pirogov Russian National Research Medical University, Ministry of Health of Russia
ORCID iD: 0000-0003-4669-1006
Department of Faculty Therapy named after Academician A. I. Nesterov
1 Ostrovityanova St., Moscow 117997
Russian FederationN. V. Galimova
Pirogov Russian National Research Medical University, Ministry of Health of Russia
ORCID iD: 0000-0002-9836-5686
Department of Faculty Therapy named after Academician A. I. Nesterov
1 Ostrovityanova St., Moscow 117997
Russian FederationD. P. Kotova
N.I. Pirogov First City Clinical Hospital, Moscow Health Department
ORCID iD: 0000-0003-1071-0877
8 Leninskiy Prospect, Moscow 117049 Russian Federation
D. V. Abeldyaev
Pirogov Russian National Research Medical University, Ministry of Health of Russia
ORCID iD: 0000-0002-4074-1300
Research Laboratory for Rheumatic Disease
1 Ostrovityanova St., Moscow 117997
Russian FederationG. G. Aleksanyan
Federal State Budget Institution A. N. Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation
ORCID iD: 0000-0002-3385-1624
135 Roublyevskoe Shosse, Moscow 121552 Russian Federation
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