Severe, Reversible Pulmonary Hypertension From Giant Pedunculated Left Atrial Myxoma

A 77-year-old woman with obstructive sleep apnea presented with a 3-week history of leg swelling and dyspnea on exertion. She had a dry cough and lost 10 kg over the past 2 years. Examination revealed elevated jugular venous pressure, reduced air entry in the left lower-lung field, and pedal edema. Imaging with chest computed tomography revealed a giant pedunculated left atrial myxoma to be the cause of her severe pulmonary hypertension, which was reversible with treatment.

[Cardiac Tumor on All Cusps of the Aortic Valve;Report of a Case]

An 80-year-old woman was incidentally found to have a cardiac tumor on the aortic valve by echocardiography. Papillary fibroelastoma(PFE) was strongly suspected, and urgent operation was performed to prevent embolism. Two tumors were identified arising from the left and right cusps with wide stalks, and aortic valve replacement was performed. By pathological examination, the tumors were diagnosed as PFEs. A small tumor was also found on the non-coronary cusp, which was considered as possible PFE or Lambl's excrescence. In the case of multiple PFEs on one valve, valve replacement, instead of simple excision of tumors, should be considered.

Multidisciplinary approach in the management of uterine intravenous leiomyomatosis with intracardiac extension: case report and review of literature

Uterine intravenous leiomyomatosis is an uncommon tumor, usually arising from the uterus, with nodular masses which extend intravascularly over variable distances and may reach the inferior vena cava, right atrium, and pulmonary arteries. Early diagnosis and surgical intervention are crucial as intracardiac leiomyomatosis not only causes cardiac symptoms but may result in pulmonary embolism and sudden death. Complete tumor resection is key in disease management, thus rendering cardiac-extending uterine intravenous leiomyomatosis one of the most challenging conditions for surgical treatment. The use of interventional radiology procedures can facilitate the surgical approach. We report the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and pulmonary embolism, analyzing management and surgical outcomes, highlighting the role of interventional radiology during the therapeutic pathway. Nonetheless, there are currently very few data available concerning the use of interventional radiology procedures in the therapeutic strategy of uterine intravenous leiomyomatosis with intracardiac extension.

Giant Fusiform Intracranial Aneurysm in Patient with History of Myxoma

Cardiac myxomas are benign cardiac neoplasms that can send a shower of emboli to cerebral arteries and cause cerebrovascular complications including large, fusiform intracranial aneurysms. These aneurysms result from myxomatous cells invading and weakening the vessel wall and can develop years after myxoma resection. In this clinical image, we illustrate a symptomatic, giant fusiform aneurysm that was discovered and treated 5 years after successful surgical resection of atrial myxoma.

Neonatal Cardiac Arrest From Left Ventricular Cardiac Hemangioma: A Surprising Presentation

Cardiac hemangioma is rare, even more when leading to a cardiovascular collapse in a seemingly healthy newborn. A 6-day-old neonate had a tamponade caused by a basolateral hemangioma of the left ventricle. Partial surgical resection was performed. A congenital lobular capillary hemangioma was diagnosed upon histologic examination. The patient recovered completely and shows normal development at the 12-month follow-up.

Primary cardiac angiosarcoma with right atrial wall rupture: A case report

RATIONALE

Cardiac angiosarcoma is the most common malignant tumor of the heart and a rare disease with rapid disease progression and poor prognosis. Cardiac wall rupture is an extremely rare complication.

PATIENT CONCERNS

A 32-year-old woman presented with an acute onset of epigastric pain and chest discomfort at first time when she visited an emergency room.

DIAGNOSES

A cardiac mass was identified on echocardiography and subsequently performed chest computed tomography and cardiac magnetic resonance imaging revealed the cardiac tumor at right atrium with right atrial wall rupture and hematogenous lung metastasis. Histopathologic diagnosis of metastatic angiosarcoma was done by open lung biopsy.

INTERVENTIONS

The patient was treated with palliative chemotherapy for the primary cardiac tumor and hematogenous lung metastasis.

OUTCOMES

The follow-up imaging studies revealed treatment response of the primary cardiac tumor and hematogenous lung metastasis.

LESSONS

Clinical and radiologic evaluation of the cardiac angiosarcoma was well performed in our case with various diagnostic imaging modalities including echocardiography, chest computed tomography, cardiac magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography/computed tomography. This case report well demonstrates typical imaging findings of a rare cardiac tumor and emphasizes importance of early investigation for accurate diagnosis and proper management of the cardiac tumor.

A rare case of intracardiac fibrosarcoma with myxoid features inducing venous occlusion in a dog - a case report

BACKGROUND

In both humans and animals, cardiac fibrosarcoma is rare among primary cardiac malignant neoplasia. The overall prevalence of cardiac neoplasia in dogs is low, reported to be between 0.17% and 0.19% of hospital admissions. The aim of this report is to describe the clinical and pathological findings of a dog presenting signs of right sided congestive heart failure due to an intracardiac and venous obstructing mass, diagnosed by histopathology as cardiac fibrosarcoma with myxoid features.

CASE PRESENTATION

A 7 years old male mix breed Husky weighing 23 kg was presented to our Veterinary Teaching Hospital the owner reporting weight loss, inappetence and exercise intolerance and on presentation exhibited breathlessness and an enlarged abdomen. A 5 minutes six leads electrocardiogram and cardiac ultrasonography were performed using standard, established techniques. Complete blood count, serum liver enzyme activities and renal parameters were assessed. Shortly after the cardiologic examination, the dog died and necropsy examination of the cardiovascular system revealed an elongated and branched mass attached dorsally to the endocardial insertion of the septal tricuspid valve leaflet. This mass extended retrogradely into the lumen of the cervical veins, obstructing the venous flow. Histological diagnosis of the mass was cardiac fibrosarcoma with myxoid features. Multiple metastases were found inside the lungs only.

CONCLUSION

This is the first report describing a right cardiac fibrosarcoma with myxoid features and venous obstruction in a dog. Cardiac fibrosarcoma is a rare finding, however should be considered when an intracardiac mass is diagnosed.

"A ball in a cage"

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A case report of left atrial myxoma-induced acute myocardial infarction and successive stroke

RATIONALE

Left atrial myxoma is a common primary cardiac tumor, however, due to poor image quality or atypical myxoma images, it is often misdiagnosed by echocardiograph. A case of left atrial myxoma being misdiagnosed as a thrombus, which successively caused acute myocardial infarction (AMI) and stroke, is very rare. Contrast-enhanced echocardiography can play an important role in definitive diagnosis.

PATIENT CONCERNS

A 44-year-old woman was diagnosed AMI because of chest pain with no significant stenosis in the coronary arteries. One month later, the patient was suddenly found unconscious, magnetic resonance imaging (MRI) showed acute multiple cerebral infarctions in the left cerebral hemisphere.

DIAGNOSES

Left atrial myxoma, acute myocardial infarction, and stroke.

INTERVENTIONS

The patient was given a cardiac surgery for tumor resection, the mass was surgically removed and histopathologic findings showed myxoma.

OUTCOMES

After several weeks of rehabilitation, the patient was able to resume daily activities without chest discomfort or dyspnea. One year later, echocardiography showed no recurrence of left atrial myxoma. The patient generally was in good condition.

LESSONS

Although myxoma is mostly benign, this patient occurred AMI and stroke because of misdiagnosis. Comprehensive assessments should be performed with multiple imaging methods for cardiac masses. If necessary, contrast-enhanced echocardiography should be used to clarify, so as not to delay the timing of surgery and bring potential risk of death to patients.

[Surgical Experience of Papillary Fibroelastoma Revealed by Cerebral Infarction]

Primary cardiac tumors are relatively rare. Among them, papillary fibroelastoma (PFE) is the 2nd most common benign cardiac tumor after myxoma. However, despite its benign status, PFE may trigger fatal embolic events in some cases. Therefore, once PFE is diagnosed, immediate surgical resection of the tumor is recommended. We report our experience of 3 patients with cerebral infarction that were diagnosed as having PFE. All cases were complicated with cerebral infarction probably originating from a tumor embolus or thrombus. For that reason, after the tumor had been detected, urgent surgical resection of the tumor was considered to be necessary. Given the generally good postoperative outcomes, simple resection of the tumor while preserving valve function is considered sufficient to achieve a favorable outcome.

Hemodynamic management of a patient with a huge right atrium myxoma during thoracic vertebral surgery: A case report

RATIONALE

Myxoma is the most common primary benign cardiac tumor, which could lead to some fatal complications because of its strategic position.

PATIENT CONCERNS

The patient was admitted to our hospital due to sudden onset of palpitation, chest tightness, mild fever, night sweats, accompanied with bilateral lower extremities adynamia, and paralysis for 5 days, but no obvious syncope and edema.

DIAGNOSES

Transthoracic echocardiography showed a giant mobile myxoma (72 × 58 mm) in the right atrium (RA). Magnetic resonance imaging revealed an erosive space-occupying lesion located between the first and third thoracic vertebrae.

INTERVENTIONS

Thoracic vertebral lesions were resected immediately to rescue the incomplete paraplegia. After the patient was placed in the prone position, significant hemodynamics changes were observed due to the displacement of the huge RA myxoma.

OUTCOMES

Stable hemodynamics was maintained during the operation through control of fluid infusion combined with vasoactive drugs.

LESSONS

Change in body position may lead to obstruction of intracardiac blood flow in patients with giant myxoma. This clinical manifestation is rarely reported.

Stroke and peripheral embolisms in a pediatric patient with giant atrial myxoma: Case report and review of current literature

RATIONALE

Cerebral stroke with peripheral embolism due to left atrial myxoma is very rare in children. Misdiagnosis may occur because of nonspecific symptoms in the heart.

PATIENT CONCERNS

We present a case of a 16-year-old boy who presented with ischemic stroke and embolisms in the lower extremity, caused by a giant left atrial myxoma.

DIAGNOSES

Left atrial myxoma.

INTERVENTIONS

A giant gelatinous mass was completely excised, and the histopathological findings confirmed the diagnosis of atrial myxoma.

OUTCOMES

The temperature of the right lower extremity recovered gradually, and pulse of the right dorsalis pedis artery became palpable 10 days after the surgery. The strength of the bilateral lower extremity was level 5 at discharge.

LESSONS

Our case, along with the review of the literature, highlights the fact that myxomas often initially present with multiple embolisms but with few cardiac symptoms. Transthoracic echocardiography should be performed immediately to make a definitive diagnosis.

Right atrial epithelioid angiosarcoma with multiple pulmonary metastasis confirmed by multimodality imaging-guided pulmonary biopsy: A case report and literature review

RATIONALE

Primary cardiac tumors are very rare, and angiosarcoma accounts for about 33% of all primary malignant cardiac tumors. Primary cardiac epithelioid angiosarcoma is a highly aggressive and difficult to diagnose tumor, with early systemic metastasis and poor prognosis.

PATIENT CONCERNS

A 35-year-old Han male experienced sudden severe palpitation and moderate dyspnea. The patient received a whole body F-18 fluoro-deoxyglucose positron emission tomography (18F-FDG PET)/computed tomography (CT) scan, the scan showed a large mass in the right atrium (RA) and numerous pulmonary nodules in both lungs.

DIAGNOSES

The patient was diagnosed as right atrial epithelioid angiosarcoma with multiple pulmonary metastasis by pulmonary biopsy through CT-guided percutaneous transthoracic fine needle aspiration.

INTERVENTIONS

The patient received a cycle of chemotherapy with docetaxel and gemcitabine, followed by another cycle with epirubicin and ifosfamide.

OUTCOMES

The chemotherapy was ineffective. After the two cycles, the bilateral pleural effusion steadily increased, the patient had severe dyspnea and palpitation, and died three weeks later, with an overall survival of 2.5 months.

LESSONS

Primary angiosarcoma of heart is a very rare and aggressive disease, and its diagnosis and treatment are difficult. Most patients may have systemic metastasis at diagnosis, and have a very short survival without surgical resection. Hence, early diagnosis and surgical resection is extremely important to treat this disease.

Calcified inferior vena cava and right atrial myxoma in an 18-month-old male: A case report

INTRODUCTION

Cardiac myxomas are the most frequent primary cardiac tumor in adults. The incidence in pediatric patients is extremely low. Heavy calcification of an atrial myxoma is uncommon in children.

CASE PRESENTATION

An 18-month-old boy was admitted for a significant precordial systolic murmur. Transthoracic echocardiography revealed a cardiac mass extending from the inferior vena cava across the right atrium and tricuspid valve into the right ventricle with severe tricuspid regurgitation. According to the echocardiography result, the patient was diagnosed with an inferior vena cava and right atrial tumor with tricuspid regurgitation. After the diagnosis, the patient underwent removal of the tumor via median sternotomy. The mass was removed under cardiopulmonary bypass with deep hypothermia circulatory arrest. The tricuspid valve was repaired by valvuloplasty and annuloplasty. The postoperative recovery was unremarkable. Follow-up echocardiogram at 1 month revealed moderate tricuspid regurgitation without myxoma recurrence.

CONCLUSION

Heavy calcification of an atrial myxoma is uncommon especially in children. Definitive therapy for myxomas requires prompt surgical excision and long-term follow-up is recommended in children although recurrence after excision is rare.

The advantages of live/real-time three-dimensional echocardiograhy in the assessment of left ventricular myxoma, which causes partial left ventricular outflow tract obstruction

Myxomas are the most common cardiac primary tumors; however, left ventricular myxomas are extremely rare. We describe a young female patient with a giant left ventricular myxoma causing partial obstruction of the left ventricular outflow tract, who underwent successful surgical resection. Real-time three-dimensional echocardiography yielded incremental value to two-dimensional echocardiography by allowing better assess of the true size, extent, attachment, and morphology of the tumor. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:273-277, 2018.

Malignant Pericardial Mesothelioma. Report of two Cases, Review of the Literature and Differential Diagnosis

Malignant pericardial mesothelioma is an uncommon variety of a primary malignant cardio-pericardial tumor and it is a highly lethal and fortunately rare cardiac neoplasm. The presentation of pericardial mesothelioma is aspecific and pathologically mesothelioma is not the most common among primary tumors of the pericardium. It is characterized by atypical solid growth of mesothelium with formation of atypical cavities surrounded by fibrous stroma. Antemortem diagnosis is difficult and distant metastases are extremely rare. Radical surgery can be used to treat localized mesothelioma. The treatment for advanced primary pericardial mesothelioma is usually palliative because the tumor is resistant to radiotherapy and chemotherapy. The prognosis is unfavorable. The median survival from the onset of symptoms is six months. In this paper we report two cases of patients with primary mesothelioma of the pericardium without a definite history of asbestos exposure.

Mesothelioma of the Pericardium: Report of a Case

One case of cardiac tamponade from malignant mesothelioma of the pericardium is reported. The tumor was diagnosed by cytology of the fluid drained by pericardial centesis. Necroscopy and histology confirmed the diagnosis.

The Role of Carcinoembryonic Antigen (CEA) and Neuron-Specific Enolase (NSE) Evaluation in Pericardial Fluid for the Recognition of Malignant Pericarditis

This study was designed to assess the value of tumor marker evaluation in pericardial fluid for the recognition of malignant pericarditis. Thirty-six patients with signs and symptoms of large pericardial effusion entered the study. Pericardiocentesis with pericardial fluid drainage was performed in all of them. CEA and NSE levels were evaluated in the pericardial fluid and compared to pericardial fluid cytology. The median CEA value in malignant effusions was 80 ng/ml (range 0-305 ng/ml) and in non-malignant ones 1.26 ng/ml (range 0.2-18.4 ng/ml), p<0.01. The sensitivity of CEA elevation above 5 ng/ml for the recognition of malignant pericarditis was 73% and the specificity was 90%.

Pericardial fluid cytology was positive in 22 of 26 patients with malignant pericarditis (85%). CEA exceeding 5 ng/ml or positive cytology were seen in 96% of the patients with malignant pericarditis. The median NSE value in malignant pericardial effusions was 41.8 μg/l (range 2-172 μg/l) and in non-malignant ones 5.85 μg/l (range 1-83.9 μg/l), p<0.3. For the differential diagnosis of large pericardial effusions we would recommend simultaneous cytologic examination of pericardial fluid and CEA assessment. NSE measurement in hemorrhagic pericardial fluid is of limited value.