Abdominal Aortic Occlusion

Myxomas, which are benign tumors, are typically pedunculated and highly mobile, passing in and out of the atrioventricular valves. Their mobility, gelatinous consistency, and friable surfaces enhance their embolic potential. In most cases of embolization, the emboli obstruct the cerebral arteries; occasionally, the visceral or coronary arteries are blocked. Tumor emboli rarely cause abdominal aortic occlusion or a saddle embolus. ^1,2

A 79-year-old man was admitted to our institution with an acute episode of abdominal pain followed by weakness in both legs. At the clinical examination, bilateral femoral pulses were absent; paralysis and anesthesia of both legs were also noted. A computed tomographic scan of the abdomen showed what appeared to be embolic occlusion of the abdominal aorta at the L4 level (Fig. 1). The patient underwent catheter embolectomy via a bilateral femoral approach. The retrieved materials were found to be tumor emboli (Fig. 2), which in turn were shown, by means of a histologic examination, to be from a cardiac myxoma. Immediately after the procedure, the patient's pain resolved, and he regained normal muscle strength in his lower extremities. Transthoracic echocardiography then revealed a left atrial myxoma (Fig. 3). The patient underwent tumor excision under cardiopulmonary bypass on the following day. The postoperative course was uneventful, and he was discharged 7 days after the operation.

Fig. 1 Abdominal computed tomographic scan reveals occlusion of the lower abdominal aorta. The arrowhead indicates the embolic occlusion.

Fig. 2 The retrieved tumor emboli. The white arrowheads indicate the tumor emboli (about 2.5 × 1.5 × 1.0 cm) from the lower abdominal aorta. The black arrowheads indicate the tumor fragments (about 1.5 × 0.5 × 0.5 cm) from the distal femoral arteries.

Fig. 3 Transthoracic echocardiogram in the parasternal long-axis view shows the myxoma prolapsing into the left ventricle. A = left atrium, M = myxoma; V = left ventricle

The clinical presentation of our case was very similar to that of a previous report by Horn and colleagues, ² but our patient made a complete recovery. Our case emphasizes that, because peripheral embolization of a cardiac myxoma is a common sequela, any embolectomy specimen should be examined carefully for gross and histologic evidence of myxomatous character. Transthoracic echocardiography is the best diagnostic technique. Once it was discovered in our patient, the left atrial myxoma was excised with the patient under cardiopulmonary bypass, thus removing the risk of further embolic complications. ¹