Shanda H. Blackmon, MD, MPH, Edmund S

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Left Atrial Myxoma Embolus to the Renal Artery: Should a Nephrectomy Be Advised? Shanda H. Blackmon, MD, MPH, Edmund S. Kassis, MD, Yimin Ge, MD, Rick Goldfarb, MD, Michael Reardon, MD The Annals of Thoracic Surgery Volume 90, Issue 1, Pages 289-292 (July 2010) DOI: 10.1016/j.athoracsur.2009.11.059 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Left ventricular mass with a gelatinous consistency. The Annals of Thoracic Surgery 2010 90, 289-292DOI: (10.1016/j.athoracsur.2009.11.059) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Left ventricular tumor consisting of a glistening, tan-yellow lesion attached to the posterior leaflet of the mitral valve and the ventricular wall. The Annals of Thoracic Surgery 2010 90, 289-292DOI: (10.1016/j.athoracsur.2009.11.059) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Nephrectomy specimen exhibited a diffuse parenchymal infarction. The lower pole and a few small scattered areas of residual normal kidney were spared. The Annals of Thoracic Surgery 2010 90, 289-292DOI: (10.1016/j.athoracsur.2009.11.059) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Renal artery tumor thrombus. In this figure, the renal artery at the hilum is opened and contains a free-floating thrombus that is firmly attached to the wall, deep at the renal interface (arrow). The proximal resection margins were negative. The Annals of Thoracic Surgery 2010 90, 289-292DOI: (10.1016/j.athoracsur.2009.11.059) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) Microscopically, the renal arterial thrombus is attached to the wall of the artery. Notice the internal elastica of the artery (×20). (B) Under high-power examination, the renal arterial thrombus is composed of spindle cells, stellate cells, abundant myxoid stroma, and scattered newly formed blood vessels. The cells appear viable (×400). Both slides are stained with hematoxylin and eosin. The Annals of Thoracic Surgery 2010 90, 289-292DOI: (10.1016/j.athoracsur.2009.11.059) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Renal ultrasound demonstrates the lack of arterial perfusion restricted to the distal segment of the renal artery. The proximal and middle segments of the renal artery were free of a filling defect, narrowing, and evidence of myxomatous emboli. The Annals of Thoracic Surgery 2010 90, 289-292DOI: (10.1016/j.athoracsur.2009.11.059) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions