title: Imaging and intervention of paraneoplastic effect of a right atrial myxoma on factor VII activity levels.
abstract: We present the case of a 64-year-old Pakistani man with right atrial myxoma, recently diagnosed with acquired severe factor VII (FVII) deficiency. The patient presented with a history of chronic hiccups and weight loss. Initial evaluation revealed an isolated prolonged prothrombin time, severely reduced FVII activity level, and a giant right atrial myxoma protruding into the right ventricle on computed tomographic thorax and echocardiography. After surgical resection, the patient maintained normal prothrombin time with increased FVII activity level in the immediate 24 hours postoperatively, and a dramatically high level of FVII activity at the 2-month follow-up. We believe that the paraneoplastic effect of myxoma on the FVII activity levels is previously unreported. In addition, we believe that hiccups as a presenting symptom for a myxoma with an atypical origin from the lateral wall of the right atrium has not been reported.
authors.affiliation: Section of Cardiothoracic Surgery, Department of Surgery, Medical College, Aga Khan University, and Aga Khan Hospital, Karachi, Pakistan.
authors.forename: Saulat Hasnain
authors.initials: SH
authors.lastname: Fatimi
authors.forename: Ranish
authors.initials: R
authors.lastname: Deedar-Ali-Khawaja
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Kiani
mesh_terms: D005167:Factor VII / Q000378:metabolism*; D005168:Factor VII Deficiency / Q000097:blood / Q000473:pathology* / Q000628:therapy; D006325:Heart Atria; D006338:Heart Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009232:Myxoma / Q000097:blood / Q000473:pathology* / Q000628:therapy; D010257:Paraneoplastic Syndromes / Q000097:blood / Q000473:pathology* / Q000628:therapy*
chemical_list: D005167:Factor VII