Right atrial myxoma and pulmonary embolism. Rational basis for investigation and treatment.

SUMMARY We report a case in which pulmonary embolectomy was crucial in the successful outcome of an operation to remove a right sided atrial myxoma. The association between such myxomata and embolisation is emphasised and guidelines for the rational investigation and treatment of such lesions are given. The occurrence of peripheral emboli is relatively common and well documented with left atrial myxoma,'-3 and it is not surprising, therefore, that right atrial myxoma should give rise to pulmonary emboli.4 Indeed, the association of pulmonary emboli with right atrial myxoma has been recognised at necropsy for many years; Chiari5 reported the first case in 1931. The clinical recognition of this association, however, is less well documented4 6 7 and a search of the published reports discloses only two pulmonary embolectomy8 9 performed during an operation to remove a right sided myxoma, and in neither case was the outcome successful. We report here the successful removal of a right atrial myxoma in a case where pulmonary embolectomy was crucial. Case report A 52 year old housewife was admitted with sudden swelling of the right arm accompanied by a dull ache. She complained of increasing tiredness for the six months before admission, with progressive exertional dyspnoea for the last three weeks. Her ankles had been swollen for one week. She did not admit to pain at any site nor to haemoptysis. There was nothing relevant in the past history.