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A 78 year old man was admitted because of a sudden appearance of stupor, dysarthria, and left sided hemiplegia. Physical examination revealed an irregular heart rate, an accentuated first heart sound, an “opening snap”, and a long apical mid diastolic rumbling murmur. The ECG showed atrial fibrillation. A presumptive diagnosis of mitral stenosis was made on admission. Transoesophageal echocardiography revealed a large left atrial (LA) highly mobile mass (panel A, arrow) attached to the interatrial septum and confined to the left atrium in systole. In diastole (panel B) the tumour (arrow) was seen prolapsing across the mitral valve into the left ventricle (LV) and partially obstructing it, thus producing a “tumour flop” and mimicking valvar mitral stenosis.
Shortly after admission, while awaiting surgery, the patient became comatose. A computed tomographic scan of the brain showed a large infarct in the territory of the right middle cerebral artery. The patient died the next morning. His family refused a postmortem examination.
Large mobile left atrial tumours (in this case most likely a myxoma) may mimic valvar mitral stenosis and present as an acute neurological event. This case also explains some of the physical findings in patients with left atrial tumour.