Acute Respiratory Distress after Knee Arthroplasty Due to Undiagnosed Atrial Myxoma

Zeest Khan, Bo Yang, Hari Mallidi, Pieter van der Starre

Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA..
Departments of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA.

DOI: 10.4236/ojanes.2012.23021                

Abstract

Acute postoperative respiratory distress may be caused by pneumonia, pulmonary embolism, heart failure, pneumothorax or atelectasis. We present s case report of a 78-year-old female patient who developed acute respiratory distress one day following knee arthroscopy. Because of the suspicion of pulmonary embolism, a computed tomographic angiography was made, showing the presence of an unexpected large left atrial mass, suggestive for a myxoma. She underwent successful resection of a 10 × 5 cm myxoma one week later. The report discusses the clinical manifestations of an atrial myxoma and its potentially fast growth. Bedside echocardiography should be considered the preferred diagnostic modality in case of acute postoperative respiratory distress.

Keywords

Non-Cardiac Surgery; Acute Respiratory Distress; Left Atrial Myxoma; Echocardiography; Cardiac Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	G. Ferreyra, Y. Long and V. Ranieri, “Respiratory Complications after Major Surgery,” Current Opinion in Critical Care, Vol. 15, No. 4, 2009, pp. 342-348. doi:10.1097/MCC.0b013e32832e0669
[2]	C. Owers, P. Vaughan, P. Braidley, G. Wilkinson, T. Locke, G. Cooper, N. Briffa, D. Hopkinson and P. Sarkar, “Atrial Myxomas: A Single Unit’s Experience in the Modern Era,” Heart Surgery Forum, Vol. 14, No. 2, 2011, pp. 105-109. doi:10.1532/HSF98.20091163
[3]	J. Butany, V. Nair, A. Naseemuddin, G. Nair, C. Catton, and T. Yau, “Cardiac Tumours: Diagnosis and Management,” Lancet Oncology, Vol. 6, No. 4, 2005, pp. 219228. doi:10.1016/S1470-2045(05)70093-0
[4]	M. Panagiotou, N. Panagoulos, P. Ravazoula, L. Kaklamanis and E. Koletsis, “Large Asymptomatic Atrial Myxoma with Ossification: Case Report,” Journal of Cardiothoracic Surgery, Vol. 29, No. 3, 2008, pp. 19-21. doi:10.1186/1749-8090-3-19
[5]	J. Walpot, B. Shivalkar, I. Rodrigus, W. H. Pasteuning and R. Hokken, “Atrial Myxomas Grow Faster than We Think,” Echocardiography, Vol. 27, No. 10, 2010, pp. E128-E131. doi:10.1111/j.1540-8175.2010.01186.x
[6]	T. Matsushita, A. Huyn, T. Singh, P. Hayes, S. Armarego and P. Sea, “Mitral Valve Annular Dilatation Caused by a Left Atrial Myxoma,” Heart, Lung and Circulation, Vol. 18, No. 2, 2009, pp. 145-147. doi:10.1016/j.hlc.2007.10.017