Cerebrovascular Diseases and Skin Psudovasculitis Masquerading a Mass in The Heart Treated Surgically (Ophthalmic Artery Oocclusion Due to Left Atrial Myxoma)

Left atrial myxoma is the most common primary cardiac neoplasm, commonly grows on the upper side of atrial septum and has often mimicked connective tissue disease especially some features of vasculitis. The clinical course of the left atrial myxoma is characterized by symptoms resulting from obstructive, embolic, or “pseudovasculitis " manifestations of the tumor. Embolic ischemic manifestations are typically cerebrovascular. We described an unusual clinical presentation of left atrial myxoma in 36 years old man, which initially was assessed as PAN type vasculitis for 4 years. He presented with episodic red skin rashes, blurred vision, abdominal pain, headache and hemiparesia. Based on his symptoms, diagnosis of polyarteritis nodosa type vasculitis was made. Laboratory findings included nothing to indicate systemic vasculitis. Cardiac evaluation revealed no murmur. Brain MRI revealed left parietal cortical ischemic patchy signals. Being unresponsiveness to medical therapy led to echocardiography which demonstrated left atrial mass (2.9 in 2cm). After surgical intervention diagnosis of left atrial myxoma was approved with pathological examination. This case report emphasize that sometimes the symptoms and physical findings of cardiac tumor could simulate systemic vasculitis. Prompt clinical recognition and surgical removal are essential to prevent serious complications.