Manifestation of an intramuscular myxoma with retroperitoneal bleeding after mitral valve replacement (case report)

The article presents a clinical case of intramuscular myxoma with its rare location in iliopsoas muscle. The myxoma was manifested with retroperitoneal bleeding after cardiac surgery. A 75-year-old female patient was routinely admitted for surgical treatment of rheumatic mitral valve disease. Mitral valve replacement with biological prosthesis and tricuspid valve repair with use of cardiopulmonary bypass was performed. The patient had post-pericardiotomy syndrome with require thoracentesis procedures. After the second puncture, pain in the right hip appeared with a short-term response to analgesics, and a decrease in hemoglobin to 68 g/L. The patient was transferred to intensive care to rule out active bleeding. After diagnostic search retroperitoneal hematoma was detected with computed tomography. Laparotomy with exploration of peritoneal cavity and retroperitoneal space was performed twice – removed 600 ml hemorrhagic fluid with “clots” in total. The patient developed an acute myocardial infarction which required intra-aortic balloon pumps and multiple organ failure after re-laparotomy. The patient died due to disease complications. Histological examination of the intraoperative material and autopsy material confirmed the diagnosis of intramuscular myxoma. The retroperitoneal localization of intramuscular myxoma is uncommon, and described clinical case with rapidly progressive symptoms because of neoplasm bleeding is unique.

1. Evtushenko V.V., Zhilina A.N., Chernykh Yu.N., Katkov V.A. Surgical treatment in a rare coexistence of rheumatic mitral stenosis and left atrial myxoma: a case report. Siberian Journal of Clinical and Experimental Medicine. 2023;38(2):281–285. (In Russ.). https://doi.org/10.29001/2073-8552-2023-38-2-281-285. EDN: SIMLFP

2. Sukpanichyingyong S., Matsumoto S., Ae K. et al. Surgical Treatment of Intramuscular Myxoma. Indian J. Orthop. 2021;55(4):892–897. https://doi.org/10.1007/s43465-021-00367-9. EDN: OZYSMW

3. Khairullin A.A., Klimentov M.N., Kuklin D.N., Sysoyev S.V. Intramuscular Myxoma, Mimicking a Psoas Abscess. Russian Sklifosovsky Journal “Emergency Medical Care”. 2023;12(4):702–705. (In Russ.). https://doi.org/10.23934/2223-9022-2023-12-4-702-705. EDN: BTMLJX

4. Hipólito-Reis J., Roque D., Teixeira J.C. Lumbar paraspinal intramuscular myxoma: A case report. Surg. Neurol. Int. 2023;14:86. https://doi.org/10.25259/SNI_141_2023. EDN: LBZOOE

5. Kim J.Y. Soft tissue myxoma manifesting as a slowly growing subcutaneous mass in the anterior chest wall: A case report. Radiol. Case Rep. 2024;19(7):2756–2759. https://doi.org/10.1016/j.radcr.2024.03.054.

6. Tsoi E.I., Falkovskaya A.Yu., Evtushenko V.V., Mordovin V.F. A case of clinically malignant rapid-progressive cardiac myxoma after COVID-19 infection. Kardiologiia. 2022;62(9):74–78. (In Russ.). https://doi.org/10.18087/cardio.2022.9.n1624. EDN: YLXFAO

7. Bancroft L.W., Kransdorf M.J., Menke D.M. et al. Intramuscular myxoma: characteristic MR imaging features. AJR Am. J. Roentgenol. 2002;178(5):1255–1259. https://doi.org/10.2214/ajr.178.5.1781255

8. Shi J., Dai T., Yang R., Sun Z. Diagnostic value of ultrasonography and other imaging examinations in patients with intramuscular myxoma: A case series and literature review. Clin. Imaging. 2020;68:161–165. https://doi.org/10.1016/j.clinimag.2020.06.027

9. Reiter A., Trumm K., Ballhause T.M. et al. Diagnostic and therapeutic pathways of intramuscular myxoma. Diagnostics (Basel). 2022;12(7):1573. https://doi.org/10.3390/diagnostics12071573

10. Saleh E.S. Pediatric Obturator Internus Muscle Myxoma. J Am Acad Orthop Surg Glob Res Rev. 2021;5(1):e20.00099. https://doi.org/10.5435/JAAOSGlobal-D-20-00099