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
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.