Answer to CC #9

Case Challenge #9 presented a 52 year old female with fever, new-onset weakness, and dyspnea on exertion associated with weight loss and a rash. She is afebrile, has petechiae on her fingertips, left-sided weakness. Heart sounds reveal a CARDIAC “PLOP.” MRI reveals multifocal acute CVA in different vascular distributions.

What is the most likely diagnosis?

  • Coxiella endocarditis
  • Hereditary hemorrhagic telangiectasia
  • Whipple’s disease
  • Rheumatic fever
  • Atrial myxoma

The patient has evidence of embolic disease, presumably from a cardiac source, as evidenced by the multifocal acute CVA. The key finding here is in the heart sounds. The atrial myxoma produces a diastolic sound that is referred to as a “tumor plop.” This sound arises from obstruction to ventricular in-flow that occurs as the tumor comes to rest over the mitral annulus. For more information, click the image below to hear a short podcast about atrial myxoma and the tumor plop.