Thrombolysis and embolectomy in treatment of acute stroke as a bridge to open-heart resection of giant cardiac myxoma: A case report

Figure 1 Head computed tomography before operation, intraoperative angiography, and stent embolectomy. A: Head computed tomography showed no abnormalities; B: Cerebral angiography showed that the left middle cerebral artery was occluded (orange arrow); C: Thrombus removed with a stent (Solitaire FR 4.0 mm × 20 mm).

Figure 2 Arterial thrombosis pathology, angiography, and echocardiography. A: Histopathological image showing scattered mucinous tumor cells and streaked polygonal eosinophil stromal cells in a mucinous-like matrix (hematoxylin-eosin staining, magnification, 10 × 10); B: Cerebral angiography showing that the left middle cerebral artery was patent (orange arrow); C: Pre-operative transthoracic echocardiogram showing that the internal diameter of the left atrium and left ventricle were abnormal but an irregular, space-occupying mass was visible in the left atrium, with a pedicle in the atrial-septal space with marked motion.

Figure 3 Appearance and microscopic display of the myxoma. A: Gross pathology. The excised myxoma measured 6.5 cm × 6.0 cm × 5.0 cm. On macroscopic examination, the excised tumor was reddish brown jelly-like with an irregular surface and mucus; B: Histological examination of the surgically removed cardiac mass showing [hematoxylin-eosin staining (HE), scale bar: × 200] mucinous tumor cells that were scattered, shuttle-shaped or stellate, with medium amounts of cytoplasm, eosinophilic, oval nuclei, and no nuclear divisions seen in the mucinous-like matrix (HE, magnification 10 × 40).

Figure 4 Magnetic resonance imaging, computed tomography, and computed tomographic angiography of the head. A: Diffusion-weighted imaging showed an area of hyperintensity in the left insular lobe, frontal lobe, parietal lobe, and occipital lobe consistent with acute infarction (orange arrow); B: A small left basal ganglia infarction and no signs of intracranial bleeding were found on further computed tomographic scan (orange arrow); C: Computed tomographic angiography imaging showed left middle cerebral artery patency and no stenosis (orange arrow).