Pervez Akber Khan, Ghulam Mustafa, Muhammad Azam, Suhail Arshad.
Right Atrial Myxoma - A Rare Diagnosis in Pediatrics.
J Coll Physicians Surg Pak Jan ;11(9):579-81.

A three and-a-half years old baby girl was presented with intermittent, high grade fever and generalized dull abdominal pain of two months duration. The respiratory difficulty was progressing since fifteen days. Her growth and development was normal prior to her illness. She had taken multiple antibiotics in high dosages without any sustained improvement.

On examination, she was pale and dyspnoeic with nasal flaring, intercostal and subcostal recessions. The respiratory rate was 72/min, pulse 160/min, temperature 101oF and blood pressure 110/70 mm of Hg. The jugular venous pressure was raised. The precordium was hyperdynamic with multiple visible pulsations. The apex beat was in fifth intercostal space without any particular character. The first and second heart sounds were normal. There was a pan-systolic murmur, best audible at the tricuspid area.

There was bronchial breathing at the left lower chest and diminished breath sounds in the right lower lung. The liver was tender, pulsatile and 12 cm palpable in the right mid clavicular line. The spleen was 10 cm palpable in it`s longest axis and tender. Due to prolonged illness as well as non- specific symptoms and signs a provisional diagnosis of congestive cardiac failure due to congenital heart disease or infective endocarditis was made.

The hemoglobin was 5.6g%. The total leukocyte count was 15,200/mm3, with 79% neutrophils and 15% lymphocytes. The serum electrolytes and renal parameters were normal. The slide for malarial parasite was negative.

Three samples of blood were taken for culture, from different sites and at different times. These were sent to different laboratories, but none of these showed any growth of microorganisms. The chest x-ray revealed increased vascular markings without cardiomegally. The electro-cardiography showed right axis deviation and right ventricular hypertrophy. The ultra-sonography revealed right pleural effusion, ectopic left kidney and a mass in the right atrium adherent to the tricuspid valve. On echocardiography the diagnosis of right atrial myxoma was confirmed. The child was promptly referred for the surgery but the parents refused to undertake surgery.

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