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

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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.

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