An unusual cause of breathlessness: part 2

A72 year old man was referred to the respiratory team by the cardiologists. He had been operated on for a cardiac myxoma in the past, and was now complaining of shortness of breath. The patient had worked in the postal industry all his life, had never smoked, and consumed 10 units of alcohol a week. He had been investigated for breathlessness about 18 months previously, when a left atrial myxoma had been diagnosed and surgically excised. At this time, benign pleural thickening had been noted, which was thought to be secondary to asbestos exposure.

The patient reported that since his operation he had experienced breathlessness on minimal exertion, which was more pronounced when lying flat. He denied any swelling of his ankles. The cardiology team had repeated his echocardiogram, which was normal with no recurrence of his atrial myxoma and with normal left ventricular function. Physical examination was unremarkable.