What is the clinical evidence from this study?

Study design: Case Report. Population: Cerebral embolism due to left atrial myxoma (n=1). Intervention: Transesophageal echocardiography (TEE) vs. Transthoracic echocardiography (TTE).

What does this research mean for the field?

Transesophageal echocardiography and pathological examination of retrieved thrombi are crucial for identifying small left atrial myxomas as the cause of unexplained cerebral embolism when transthoracic echocardiography is unremarkable. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To report a case of cerebral embolism due to left atrial myxoma and highlight the role of transesophageal echocardiography.

June 2, 2026Open Access

A case of cerebral embolism due to left atrial myxoma useful in transesophageal echocardiography and pathological findings of retrieved thrombus

Key Result

Transesophageal echocardiography successfully detected a 14 × 17mm left atrial myxoma that was missed by transthoracic echocardiography in a 75-year-old man with cerebral embolism.

Key Points

To report a case of cerebral embolism due to left atrial myxoma and highlight the role of transesophageal echocardiography.
Patient underwent MRI, revealing cerebral infarction and mechanical thrombectomy performed.
Transesophageal echocardiography revealed a mobile tumor and pathology of the thrombus identified a left atrial myxoma.
Pathological examination included the analysis of retrieved thrombus with specific staining.
Cerebral infarction was localized in the right middle cerebral artery territory.
Pathology of the thrombus showed foreign body granuloma and calretinin-positive cells.
Transesophageal echocardiography detected a 14 × 17mm mobile tumor, leading to a diagnosis of left atrial myxoma.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

75-year-old man with cerebral embolism (left hemispatial neglect and left complete hemiplegia) and no apparent risk factors for cardioembolic stroke, n=1

Intervention

Transesophageal echocardiography (TEE) and pathological examination of retrieved thrombus

Comparator

Transthoracic echocardiography (TTE)

Outcome

Detection of the embolic source (left atrial myxoma)

TEE is necessary in cases of unexplained embolism as TTE may fail to detect small cardiac tumors like left atrial myxoma.

Limitations

Transthoracic echocardiography may fail to detect tumors due to factors such as small size.

Abstract

A 75-year-old man with no apparent risk factors for cardioembolic stroke was transported presenting with left hemispatial neglect and left complete hemiplegia. MRI revealed a new cerebral infarction in the right middle cerebral artery territory with diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch. The occluded vessel was the right middle cerebral artery (M1 segment). Intravenous rt-PA and mechanical thrombectomy were performed. Pathology of the retrieved thrombus revealed a foreign body granuloma and lipomatous lesion with cholesterol with some calretinin-positive cells. Electrocardiography and transthoracic echocardiography (TTE) showed no abnormalities however, a 4.2mm high-intensity homogeneous plaque in aortic arch and a 14 × 17mm mobile tumor with a stalk were observed in transesophageal echocardiography (TEE). Pathological examination of the tumor revealed a stroma rich in vascular axes and hyaline collagen fibers, with retention of Alcian blue-positive mucinous matrix, leading to a diagnosis of left atrial myxoma. Aortogenic embolism or embolism due to left atrial myxoma was considered. However, since the retrieved thrombus contained calretinin-positive cells, left atrial myxoma was diagnosed as the cause of the embolism. TTE may fail to detect tumors due to factors such as small size. Therefore, TEE is considered necessary in cases of unexplained embolism.

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