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Abstract
Purpose
We report the case of a patient diagnosed with central retinal artery occlusion caused by cardiac myxoma who under-went surgery to remove the myxoma.
Case summary
A 47-year-old woman came to our clinic presenting with a sudden decrease of visual acuity in the left eye. At the first visit, left eye visual acuity was hand motion, and intraocular pressure was 15.4 mmHg. A relative afferent pupillary defect was observed in the left eye. On fundus examination, a pale retina and cherry-red spot were observed at the posterior pole. On optical coherence tomography, macular edema was found. On fluorescein angiography and indocyanine green angiography, de-layed blood circulation of the retina and choroid was found at early and late stages. Cerebral angiography was performed in the neurosurgery department and showed no occlusion of the ophthalmic artery. Cardiac ultrasonography and brain magnetic reso-nance imaging were performed. On cardiac ultrasonography, 4.46 × 2.09 cm cardiac myxoma was found. Resection of the car-diac myxoma was conducted in the thoracic and cardiovascular surgery department. Multiple cerebral infarcts were detected by brain imaging, and antithrombotic treatment was administered. After one month, blood circulation in the retina and choroid was observed in fluorescence angiography, but there was no improvement of visual acuity. At the 3-month follow-up visit, macular edema was decreased, but retinal atrophy and epiretinal membrane were observed on optical coherence tomography.
References
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Figure 1.
Patient case. (A) Fundus photography at first visit. Ischemic change of the posterior pole and cherry-red spot were observed. (B) Optical coherence tomography showing edematous retina. (C, D) Fluorescein angiography and Indocyanine green an-giography image at first visit. (C) At the early phase of Fluorescein/Indocyanine green angiography (FAG/ICG), we could find de-layed arm to retina time (24 seconds) and delayed choroidal circulation. (D) At the late phase of FAG/ICG (7:40), hypofluorescent lesions are observed in the superior, inferior, and temporal area of the optic disc including fovea.
Figure 2.
Echocardiographic and brain magnetic resonance imaging findings. (A) Transthoracic echocardiographic finding. Mass with irregular margin in the left atrium (in subcostal view, arrow). (B) Brain magnetic resonance T2 imaging. Multiple micro-infarctions (more than 15) were found (arrows). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; MV = mitral valve.
Figure 3.
Gross and pathologic slide pictures of resected myxoma. (A) Grossly, tumor mass showed heterogeneouslymyxoid appear-ance with focal hemorrhage. (B) Tumor cells consisted of hypocellular, fibromyxoid or loose myxoid stroma (Hematoxylin and eosin stain [HE] stain, ×40). (C) Tumor cells were spindled or stellated with occasional syncytia and had indistinct cell borders and hyperchromatic nuclei (HE stain, ×400). (D) Tumor cells showed positivity for CD34 (CD34, ×100).
Figure 4.
Fluorescein angiography/Indocyanine green angiography (FAG/ICG) image (1 month later from the first visit). Optical co-herence tomography (3 months later from the first visit). (A) At the early phase of FAG/ICG, we could find recovered arm to retina time (18 seconds) and recovered choroidal circulation. (B) Optical coherence tomography shows retinal edema and epiretinal membrane.
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