In an unusual case, a teenage athlete in America who had collapsed at a trampoline park was diagnosed with a rarely seen heart tumour, the mass having been undetected by doctors for months during which he experienced erratic symptoms and was even told he might have pulled a muscle.
Nearly two dozen nurses, doctors and technicians had awaited the arrival of the 14-year-old boy at the emergency department of Children’s National Hospital in Washington that Saturday afternoon in September 2022.
The Washington Post reports that Akinbiyi Akinwumi, known as BB, had suddenly collapsed at an indoor trampoline park near his home.
He had quickly regained consciousness but had trouble speaking and complained of chest pain and numbness. Paramedics noted an unusual and worrisome elevation on his electrocardiogram and wondered if he might be having a heart attack – a rare event in someone so young.
At the hospital’s trauma bay, Gil Wernovsky, critical care cardiologist, was the first doctor to see him.
BB’s blood pressure and heart rate were normal and Wernovsky mentally ticked through a list of possible causes of his collapse: dehydration, an arrhythmia, sepsis, a life-threatening infection, myocarditis, a rare but serious inflammation of the heart wall, a drug overdose or even Lyme disease.
The paediatric cardiology fellow began to perform an echocardiogram, a test using ultrasound to assess heart function.
As an image flashed on the screen, Wernovsky recalled, there was a collective “audible gasp, followed by complete silence”.
There, in terrifying detail, was the cause of BB’s problem – and of the months of unexplained fatigue, dizziness and chest pain that preceded it.
The ER team immediately mobilised to prepare BB and his family for emergency surgery. “We had to move very quickly,” Wernovsky said. “We really didn’t know if we were minutes away from … a fatality.”
BB’s mother, Shron Akinwumi, remembers feeling simultaneously bewildered by what doctors were telling her and intent on projecting the brave face her younger son badly needed. She and her husband, Akin, a physician and epidemiologist, signed consent forms, answered questions about do-not-resuscitate orders and tried to process the warning that their previously healthy child could die in surgery.
BB’s fraught diagnosis was in sharp contrast to his unusually rapid recovery. Less than four days after the teenager had arrived critically ill, in an ambulance, he went home.
“He recovered so fast we barely had time to talk to him,” Wernovsky said.
A pulled muscle?
For months before his hospital admission, BB, a basketball player, had felt pain in his chest, numbness in his arm and periods of fatigue and sluggishness that he largely avoided mentioning. His symptoms were “very random”, recalled his mother.
When she asked the paediatrician about the pain in BB’s chest, the doctor told her he might have pulled a muscle – one of the most common causes of paediatric chest pain – and advised that he take Tylenol, which seemed to help. During previous visits doctors hadn’t found anything out of the ordinary.
In early August, six weeks before he fainted at the trampoline park, BB had gone to a gym but while working out had complained of feeling dizzy, “tingly and generally not right”. He then briefly passed out.
His mother arrived to find him on the pavement, where he had vomited. BB had been wearing a hoodie and Shron thought he might be suffering from heat stroke or a migraine with aura.
For two years he had experienced infrequent headaches, which typically responded to over-the-counter medicine.
At home, BB took a brief nap. When he awoke and said he didn’t remember being at the gym, his mother initially thought he was joking.
When she realised he wasn’t, she called 911. Paramedics examined him; his vital signs were normal but an EMT suggested she take him to the hospital.
The pair spent six hours in the ER. BB’s memory returned and his neurological tests were normal.
A follow up with his paediatrician had him being referred to the hospital’s cardiology clinic after an ECG showed left ventricular hypertrophy, thickening in the left chamber of the heart that can be caused by high blood pressure, a heart valve problem or intensive athletic training.
The paediatrician told his mother the episode might be migraine-related and advised that he take it easy.
Six weeks later, just after dropping BB at the trampoline park, his mother was phoned by a supervisor who said her son had “gone limp” mid-jump; an ambulance had been called.
She followed the ambulance to Children’s National Hospital.
What they found
Looking at the screen, the medical team was thunderstruck. BB spoke up. “That’s not supposed to be there,” he said. A large growth shaped like a stalk of cauliflower was attached to his heart; it resembled a tree swaying in a hurricane.
The odd-looking mass attached to the left side of BB’s heart was a tumour, doctors told his mother. It wasn’t clear if it were benign or malignant, but it had to come out immediately.
Wernovsky said he was virtually certain the tumour was a cardiac myxoma – a mass that is rare in adults and even rarer in children. In his 38-year career the cardiologist has seen two others: one in a newborn, the other in a 10-year-old.
Myxomas are nearly always benign, although BB’s was “in a malignant place. I can’t think of a scarier activity than jumping on a trampoline”, Wernovsky noted, because the huge tumour easily could have blocked blood flow to BB’s heart, killing him instantly.
The cause of cardiac myxomas, which typically affect the heart’s upper chamber, is largely unknown. Many are diagnosed in women between 30 and 60 and discovered incidentally during a work-up for something else. About 10% are believed to result from a rare genetic disorder called Carney syndrome, but most occur randomly, as did BB’s.
Surgical removal is the recommended treatment for the tumours, which rarely recur.
The operation went well. Within a day BB was moved out of the cardiac ICU. His mother remembers asking why so many doctors were examining him and being told that the visits were prompted by the rarity of his tumour and the speed of his recovery.
It was only as BB was recovering that his mother learned that he had experienced months of symptoms he had rarely mentioned. A few weeks after his surgery, he told his mother he felt much better than he had in years.
BB has resumed playing basketball but currently avoids contact sports and strenuous activity. Because he has had open heart surgery he will need an annual follow-up with a cardiologist for the rest of his life.
To Wernovsky, BB’s experience, which has been used as a teaching case for young doctors, is a reminder of the importance of thinking broadly when evaluating symptoms.