PDF(Pubmed)
Abstract：
UNASSIGNED: Presenting symptoms of atrial myxoma are classically viewed as a triad of cardiac, embolic, and constitutional symptoms. Dermatologic manifestations are viewed as constitutional symptoms and have not received much attention.
UNASSIGNED: Illustrative case presentation and literature review.
UNASSIGNED: I admitted a 28 y woman transferred to the comprehensive stroke center with an ischemic stroke treated with intravenous thrombolysis. She had a two year history of skin lesions in the hands/fingers and feet/toes/sole. Skin biopsies showed perivascular neutrophilic inflammatory dermatitis without skin vasculitis. Admission physical exam was notable for chronic skin changes on her hand and foot and an acute erythematous petechial rash over the right side of her face in the distribution of the right external carotid artery. MRI brain showed ischemia involving the right internal carotid artery territory. Transthoracic echocardiogram identified a 2.4 cm atrial myxoma with normal mitral valve function. She underwent uncomplicated cardiac surgery with confirmation of a villous myxoma. At her 8 week follow up visit, she had resolution of her neurologic deficits, and her skin rashes had cleared.Literature review identified 17 additional published cases of sentinel rashes preceding diagnosis of atrial myxoma. Skin changes were often reported in the hand and feet and may involve the digits, palm, and sole. In 8 cases, skin biopsy identified myxomatous emboli in dermal vessels. These cutaneous manifestations share similarities with Osler nodes and Janeway lesions first described in the 1890\'s, now understood to represent microemboli to the dermis. Seven of these 17 cases (41 %) developed strokes after the initial presentation of cutaneous changes. Our patient had an embolic event primarily affecting the right common carotid artery territory with facial cutaneous changes due to emboli to the external carotid artery territory and cerebral ischemia in the right internal carotid artery territory.
UNASSIGNED: I recommend reclassification of the cutaneous signs of atrial myxoma as embolic (to the dermis microvasculature) rather than a constitutional symptom. As the skin biopsy often fails to show myxomatous emboli, physicians should have a high suspicion for a proximal embolic source for patients with a migratory rash preferentially affecting distal extremities. Earlier diagnosis of atrial myxoma when the sentinel rash first appears provides a valuable window of opportunity for cardiac surgery before the patient experiences stroke or peripheral emboli.
UNASSIGNED: Illustrative case presentation and literature review.
UNASSIGNED: I admitted a 28 y woman transferred to the comprehensive stroke center with an ischemic stroke treated with intravenous thrombolysis. She had a two year history of skin lesions in the hands/fingers and feet/toes/sole. Skin biopsies showed perivascular neutrophilic inflammatory dermatitis without skin vasculitis. Admission physical exam was notable for chronic skin changes on her hand and foot and an acute erythematous petechial rash over the right side of her face in the distribution of the right external carotid artery. MRI brain showed ischemia involving the right internal carotid artery territory. Transthoracic echocardiogram identified a 2.4 cm atrial myxoma with normal mitral valve function. She underwent uncomplicated cardiac surgery with confirmation of a villous myxoma. At her 8 week follow up visit, she had resolution of her neurologic deficits, and her skin rashes had cleared.Literature review identified 17 additional published cases of sentinel rashes preceding diagnosis of atrial myxoma. Skin changes were often reported in the hand and feet and may involve the digits, palm, and sole. In 8 cases, skin biopsy identified myxomatous emboli in dermal vessels. These cutaneous manifestations share similarities with Osler nodes and Janeway lesions first described in the 1890\'s, now understood to represent microemboli to the dermis. Seven of these 17 cases (41 %) developed strokes after the initial presentation of cutaneous changes. Our patient had an embolic event primarily affecting the right common carotid artery territory with facial cutaneous changes due to emboli to the external carotid artery territory and cerebral ischemia in the right internal carotid artery territory.
UNASSIGNED: I recommend reclassification of the cutaneous signs of atrial myxoma as embolic (to the dermis microvasculature) rather than a constitutional symptom. As the skin biopsy often fails to show myxomatous emboli, physicians should have a high suspicion for a proximal embolic source for patients with a migratory rash preferentially affecting distal extremities. Earlier diagnosis of atrial myxoma when the sentinel rash first appears provides a valuable window of opportunity for cardiac surgery before the patient experiences stroke or peripheral emboli.
摘要：
■心房粘液瘤的症状通常被视为心脏的三联征，栓塞,和体质症状。皮肤病表现被视为体质症状，并没有受到太多关注。
■案例介绍和文献综述。
■我收治了一名28岁的女性患者，她被转移到综合卒中中心，患有缺血性卒中，接受了静脉溶栓治疗。她的手/手指和脚/脚趾/脚底有两年的皮肤损伤史。皮肤活检显示血管周围中性粒细胞炎性皮炎，无皮肤血管炎。入院体检值得注意的是，她的手和脚的慢性皮肤变化以及右颈外动脉分布中面部右侧的急性红斑斑疹。MRI显示脑缺血累及右侧颈内动脉区域。经胸超声心动图确定了2.4厘米的心房粘液瘤，二尖瓣功能正常。她接受了简单的心脏手术，并确认了绒毛粘液瘤。在她为期8周的随访中，她已经解决了她的神经缺陷，她的皮疹已经清除了.文献综述在诊断为心房粘液瘤之前确定了另外17例前哨皮疹。皮肤变化通常在手和脚报告，可能涉及手指，棕榈,和鞋底。在8个案例中，皮肤活检发现真皮血管中的粘液瘤栓子。这些皮肤表现与1890年代首次描述的奥斯勒淋巴结和简威病变有相似之处，现在被理解为代表真皮的微栓子。这17例中有7例（41％）在最初出现皮肤变化后出现中风。我们的患者发生了主要影响右侧颈总动脉区域的栓塞事件，由于颈外动脉区域的栓塞和右侧颈内动脉区域的脑缺血而导致面部皮肤变化。
■我建议将心房粘液瘤的皮肤征象重新分类为栓塞（至真皮微脉管系统），而不是体质症状。由于皮肤活检通常无法显示粘液瘤栓子，对于游走性皮疹优先影响远端四肢的患者,医师应高度怀疑近端栓塞来源.当前哨皮疹首次出现时，心房粘液瘤的早期诊断为患者中风或周围栓塞之前的心脏手术提供了宝贵的机会窗口。
■案例介绍和文献综述。
■我收治了一名28岁的女性患者，她被转移到综合卒中中心，患有缺血性卒中，接受了静脉溶栓治疗。她的手/手指和脚/脚趾/脚底有两年的皮肤损伤史。皮肤活检显示血管周围中性粒细胞炎性皮炎，无皮肤血管炎。入院体检值得注意的是，她的手和脚的慢性皮肤变化以及右颈外动脉分布中面部右侧的急性红斑斑疹。MRI显示脑缺血累及右侧颈内动脉区域。经胸超声心动图确定了2.4厘米的心房粘液瘤，二尖瓣功能正常。她接受了简单的心脏手术，并确认了绒毛粘液瘤。在她为期8周的随访中，她已经解决了她的神经缺陷，她的皮疹已经清除了.文献综述在诊断为心房粘液瘤之前确定了另外17例前哨皮疹。皮肤变化通常在手和脚报告，可能涉及手指，棕榈,和鞋底。在8个案例中，皮肤活检发现真皮血管中的粘液瘤栓子。这些皮肤表现与1890年代首次描述的奥斯勒淋巴结和简威病变有相似之处，现在被理解为代表真皮的微栓子。这17例中有7例（41％）在最初出现皮肤变化后出现中风。我们的患者发生了主要影响右侧颈总动脉区域的栓塞事件，由于颈外动脉区域的栓塞和右侧颈内动脉区域的脑缺血而导致面部皮肤变化。
■我建议将心房粘液瘤的皮肤征象重新分类为栓塞（至真皮微脉管系统），而不是体质症状。由于皮肤活检通常无法显示粘液瘤栓子，对于游走性皮疹优先影响远端四肢的患者,医师应高度怀疑近端栓塞来源.当前哨皮疹首次出现时，心房粘液瘤的早期诊断为患者中风或周围栓塞之前的心脏手术提供了宝贵的机会窗口。
