Massive left atrial myxoma uncommon presentation in an aged Man, an educational case report and literature review

BACKGROUND: Cardiac myxomas are the most common primary tumors of the heart, although they remain rare overall, particularly in elderly male patients. Left atrial myxomas typically present with nonspecific constitutional symptoms or remain asymptomatic, making diagnosis challenging. However, their potential to cause embolic phenomena highlights the critical need for timely recognition. We present a case of a large left atrial myxoma in a 76-year-old man, in whom initial symptoms were erroneously attributed to insulin-induced hypoglycemia, resulting in a delay in diagnosis. CASE PRESENTATION: A 76-year-old man with a history of diabetes and hypertension presented with aphasia following multiple episodes of syncope over two months. Initial evaluations, including non-contrast brain computed tomography, were unremarkable, but the brain magnetic resonance imaging revealed evidence of embolic strokes. Transthoracic echocardiography identified a large, mobile left atrial mass measuring approximately 59 mm, occupying 90% of the left atrial cavity and prolapsing through the mitral valve during diastole. The patient underwent urgent surgical excision of the mass, which was confirmed histopathologically as a myxoma. Postoperative recovery was uneventful, with complete resolution of neurological deficits and no recurrence of symptoms during follow-up. CONCLUSIONS: This case highlights the diagnostic challenges of left atrial myxoma in elderly male patients, particularly when stroke is the initial manifestation and symptoms are subtle or misattributed. The patient made a full neurological recovery following timely surgical resection. The case underscores the importance of considering cardiac sources-such as myxoma-in the evaluation of cryptogenic stroke and supports the early use of echocardiography in elderly patients with unexplained neurological events.