Delayed hemorrhagic cerebral metastases after atrial myxoma resection: Report of two cases and review of the literature

Cardiac myxomas are the most frequent primary tumors of the heart. Neurological manifestations of atrial myxoma are frequent and mostly occur as a result of embolization, mass effect from metastatic tumor growth, or aneurysm formation. Delayed neurological events following surgical resection of the parent tumor are however rare. The potential causes of delayed neurological manifestations that have been reported in the literature are arterial aneurysm formation and metastatic tumor growth.We present a clinical and radiological follow-up study of two patients with a myxoma producing metastatic hemorrhagic lesions in the brain following total excision of the cardiac tumor, and in the absence of intracardiac recurrence. The progressive metastatic spread with subsequent tumor growth and recurrent episodes of intratumoral hemorrhage were characterized by a clinical evolution of progressive intellectual and neurological decline. We illustrate the new-formation and evolution of these metastatic lesions by magnetic resonance imaging and describe the imaging characteristics and time-dependent changes. These unusual case histories demonstrate the capability of an atrial myxoma to cause cerebral metastases and cerebral hemorrhages, even without aneurysm formation.