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Abboud F, Nakhal R, Alshwaiki A, Hanna M, Ishkhan K. Navigating complex cardiac complications: A case report of alcoholic cardiomyopathy and right atrial thrombosis. Medicine (Baltimore) 2024; 103:e39443. [PMID: 39183404 PMCID: PMC11346856 DOI: 10.1097/md.0000000000039443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/29/2024] [Accepted: 08/05/2024] [Indexed: 08/27/2024] Open
Abstract
RATIONALE Alcoholic cardiomyopathy (ACM) is associated with various cardiac complications, but the development of isolated right atrial (RA) thrombus without deep vein thrombosis is rare and presents diagnostic challenges. PATIENT CONCERNS A 53-year-old Hispanic male presented with shortness of breath, chills, cough, bilateral lower extremity edema, and distended abdomen. DIAGNOSES The patient was diagnosed with ACM, liver cirrhosis, and a large RA thrombus. Initial transthoracic echocardiography showed severe left ventricular systolic dysfunction but failed to detect the RA mass. Subsequent computed tomography scan and transesophageal echocardiography revealed a large oval mass in the RA, measuring 40 mm × 22 mm × 18 mm. INTERVENTIONS The patient received guideline-directed medical therapy for heart failure and anticoagulation with enoxaparin. He underwent cardiac catheterization for mechanical thrombectomy, which was minimally successful. OUTCOMES The patient's condition was managed with the prescribed interventions. Regular follow-up was planned to assess thrombolysis. LESSONS RA thrombosis is an uncommon complication of ACM. A multimodal imaging approach, with a low threshold for transesophageal echocardiography, is crucial in evaluating patients with ACM who present with cardiac complications. This approach enables accurate diagnosis and management of rare conditions like isolated RA thrombosis.
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Affiliation(s)
- Fares Abboud
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Ranim Nakhal
- Department of Pathology, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Afif Alshwaiki
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Majd Hanna
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Khachig Ishkhan
- Faculty of Medicine, Aleppo University, Aleppo, Syrian Arab Republic
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Sumerkan MC, Cetin S, Helvaci FB, Yaslikaya SS, Karabay U, Hamit T, Gurdal A, Agirbasli M, Alyan O. Three-dimensional echocardiographic assessment of Chiari’s network relationship with the left ventricular false tendon. Egypt Heart J 2022; 74:49. [PMID: 35704119 PMCID: PMC9200920 DOI: 10.1186/s43044-022-00287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Left ventricular false tendon (LVFT) is a fibromuscular band crossing the left ventricular cavity. And Chiari’s network (CN) is a highly mobile, mesh-like, echogenic structure in right atrium. In this study, we aimed to evaluate the coexistence of LVFT in patients with CN. CN patients were examined with live/real-time three-dimensional transthoracic echocardiography (TTE) for visualization of LVFT. Results This is a single-center prospective study of 49 patients with CN. In literature studies, the average ratios of LVFT were 22% in the normal population. In our study, an increased ratio of LVFT (n = 31, 63.3%) was found in CN patients evaluated with a three-dimensional TTE (63.3% versus 22%) (p = 0.01). The interatrial septal aneurysm was found in 31 (63.3%) patients with CN. And, the positive contrast echocardiography examination was determined in 22 (61.1%) patients with CN. Conclusions Our study reveals that CN is associated with LVFT and is also associated with cardiac anomalies like an interatrial septal aneurysm, and atrial septal defect. And LVFT can be evaluated better with three-dimensional TTE than with traditional two-dimensional TTE. Patients with CN should be evaluated more carefully by three-dimensional echocardiography as they can be in synergy in terms of the cardiac pathologies they accompany. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-022-00287-5.
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Yalta K, Özkan U, Yalta T, Yetkin E. Cardiac myxomas in an unusual location: A glimpse into their potential characteristics. Anatol J Cardiol 2021; 25:928-930. [PMID: 34866591 DOI: 10.5152/anatoljcardiol.2021.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kenan Yalta
- Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
| | - Uğur Özkan
- Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
| | - Tülin Yalta
- Department of Pathology, Faculty of Medicine, Trakya University; Edirne-Turkey
| | - Ertan Yetkin
- Department of Cardiology, Derindere Hospital; İstanbul-Turkey
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Rohila AK, Kumar S, Khichar S, Meena DS, Pandit SK. Right Atrial Thrombus in a Patient of Rheumatic Heart Disease with Severe Mitral Regurgitation: A Rare Association. Cardiovasc Hematol Disord Drug Targets 2021; 21:202-205. [PMID: 34666647 DOI: 10.2174/1871529x21666211018104733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Right atrial thrombus is a rare phenomenon, and its incidence is not well-defined. It usually occurs in the presence of predisposing factors like tricuspid stenosis or following central venous catheterization. Isolated right atrial thrombus without any predisposing factors occurs rarely. CASE PRESENTATION We herein report a 30-year-old male patient, a known case of rheumatic heart disease with mitral regurgitation, presented with severe breathlessness and orthopnea. He was diagnosed with acute pulmonary oedema with biventricular dysfunction and congestive symptoms. On transthoracic 2D echocardiography, he was found to have severe mitral and severe tricuspid regurgitation. All cardiac chambers were dilated, and an incidental finding of right atrial thrombus was noted. The patient was managed conservatively, but he succumbed to his worsening heart failure. CONCLUSION Treating physicians should be aware of the possibility of right atrial thrombus in rheumatic mitral valve disease because of its clinical implications, like life-threatening pulmonary embolization and need of surgical management.
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Affiliation(s)
- Amit Kumar Rohila
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Saurabh Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Satyendra Khichar
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Durga Shankar Meena
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
| | - Sonu Kumar Pandit
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur. India
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5
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Verma I, Chang EY, Kumar G, Sachdeva R. Catheter directed embolectomy of right atrial clot in transit-A case series. Catheter Cardiovasc Interv 2021; 97:869-873. [PMID: 33226187 DOI: 10.1002/ccd.29391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/12/2020] [Accepted: 11/09/2020] [Indexed: 11/08/2022]
Abstract
In the previous literature, the prevalence of right atrial (RA) clot-in-transit associated with pulmonary embolism is around 4-18% with an associated mortality of 80-100% in untreated cases. Surgical thrombo-embolectomy has been the mainstay of treatment for stable patients but the data for percutaneous thrombo-embolectomy is lacking in the literature. We present a series of three cases of right atrium clot-in-transit treated with catheter-based therapies with Inari FlowTriever® (Inari Medical, Irvine, CA). Our three patients had different clinical profiles and presentations of right atrial clot-in-transit. All of the subjects had contraindications to surgical thrombo-embolectomy and thrombolytic therapy. Catheter based embolectomy using Inari FlowTriever® was successfully performed in all the patients. As the data on this intervention is sparse, our case series highlights successful catheter based thrombo-embolectomies in high-risk individuals with right atrial clot in-transit with or without pulmonary embolism.
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Affiliation(s)
- Isha Verma
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA.,Division of Cardiology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Eric Y Chang
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA.,Division of Cardiology, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Gautam Kumar
- Division of Cardiology, Atlanta Veterans Affairs Hospital, Decatur, Georgia, USA.,Division of Cardiology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA.,Division of Cardiology, Atlanta Veterans Affairs Hospital, Decatur, Georgia, USA.,Division of Cardiology, Grady Memorial Hospital, Atlanta, Georgia, USA
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6
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Kim DH, Kim SS, Kim HK. Cement Emboli Presenting as Right Atrial Mass Caused by Percutaneous Vertebroplasty. ACTA CARDIOLOGICA SINICA 2020; 36:390-393. [PMID: 32675933 DOI: 10.6515/acs.202007_36(4).20200213b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Sung Soo Kim
- Department of Cardiology, Chosun University Hospital, Donggu, Gwangju, Korea
| | - Hyun Kuk Kim
- Department of Cardiology, Chosun University Hospital, Donggu, Gwangju, Korea
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7
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A Rare Case of Intracardiac Extension of Hepatocellular Carcinoma in a Child. Case Rep Oncol Med 2019; 2019:4783595. [PMID: 31885971 PMCID: PMC6915120 DOI: 10.1155/2019/4783595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignancy found in men and ninth most common in women, out of which 72.5% reported cases are from Asia. In children, it accounts for <2% cases worldwide with even rarer incidence of 1.2% involving intracardial extension. However, it presents with a high mortality rate with mean survival ranging from 1 to 4 months. The present case is an extremely rare case of intracardiac extension of HCC in a 3.5-year-old Asian girl with no history of hepatitis B infection presented at an advanced stage of HCC who succumbed within one month of presentation to the hospital.
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Abstract
Homocystinuria is a genetic inborn error of metabolism due to the deficiency of cystathionine β-synthase resulting in increased serum homocysteine and methionine and decreased cysteine which predisposes affected individuals to arterial and venous thromboembolic phenomena. We present a case of homocystinuria who presented to us as a calcified right atrial mass during the evaluation for lower respiratory tract infection. Our case reveals an unusual mix of findings using imaging with multiple detector computed tomography and radiographs.
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Affiliation(s)
- Tahleel Altaf Shera
- Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Naseer Ahmed Choh
- Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Faiz Altaf Shera
- Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Azher Maqbool Khan
- Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Benjamin MM, Afzal A, Chamogeorgakis T, Feghali GA. Right atrial thrombus and its causes, complications, and therapy. Proc (Bayl Univ Med Cent) 2017; 30:54-56. [PMID: 28127133 DOI: 10.1080/08998280.2017.11929526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A 70-year-old man who presented with dyspnea and intermittent chest pain was found to have a large free-floating right atrial thrombus on two-dimensional echocardiogram. Atriotomy was performed, and an 18-cm-long thrombus was removed from the right atrium and inferior vena cava. Postoperatively, the patient developed cardiogenic shock treated by intravenous vasopressor agents and extracorporeal membrane oxygenation. The postoperative course was also complicated by bilateral pulmonary emboli requiring pulmonary artery thrombectomy. Right atrial thrombus is an underdiagnosed condition with a high mortality rate. The best management modality has not yet been established.
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Affiliation(s)
| | - Aasim Afzal
- Baylor University Medical Center at Dallas, Dallas, Texas
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10
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Floating right heart thrombi: A pooled analysis of cases reported over the past 10years. Am J Emerg Med 2017; 36:911-915. [PMID: 29111332 DOI: 10.1016/j.ajem.2017.10.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/14/2017] [Accepted: 10/16/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Floating right heart thrombi (FRHTS) are a rare phenomenon associated with high mortality. Immediate treatment is mandatory, but optimal therapy is controversial. OBJECTIVE To compare the clinical characteristics according to different treatment strategies and to identify predictors of mortality on patients with FRHTS. METHODS We conducted a systematic search of reported clinical cases of TTRH from 2006 to 2016. RESULTS 207 patients were analyzed, median age was 60years, 51.7% were men, 31.4% presented with shock. Pulmonary thromboembolism was present in 85% of the cases. The treatments administered were anticoagulation therapy in 44 patients (21.28%), surgical embolectomy in 89 patients (43%), thrombolytic therapy in 66 patients (31.8%), percutaneous thrombectomy in 3 patients (1.93%) and fibrinolytic in situ in 4 (1.45%). The overall mortality rate was 21.3%. The mortality associated with anticoagulation alone was higher than surgical embolectomy or thrombolysis (36.4 vs 18% vs 18.2%, respectively, p=0.03), and in percutaneous thrombectomy and fibrinolytics in situ was 0%. At multivariate analysis, only anticoagulation alone (odds ratio [OR] 2.4, IC 95% 1.07-5.4, p=0.03), and shock (OR 2.87 (IC 95% 1.3-5.9, p=0.005) showed a statistically significant effect on mortality. CONCLUSION FRHTS represent a serious form of thromboembolism that requires rapid decisions to improve the survival. Anticoagulation as the only strategy does not seem to be sufficient, while thrombolysis and surgical thrombectomy show better and similar results. A proper individualization of the risk and benefits of both techniques is necessary to choose the most appropriate strategy for our patients.
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11
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Yakar A, Yakar F, Atacan SÇ, Yıldız M, Üzün İ. Failure of Therapy at Premortem Diagnosed Pulmonary Thromboembolism. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2016. [DOI: 10.5799/jcei.328615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Gresham D, Digiacinto D. Endometrial Sarcoma With Intracardiac Extension. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/875647930201800408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endometrial stromal sarcoma with intracardiac extensions is a rare and life-threatening occurrence. Proper diagnosis through diagnostic imaging and pathologic studies is important for improved patient outcome.
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Affiliation(s)
| | - Dora Digiacinto
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma; College of Allied Health, University of Oklahoma Health Science Center, P.O. Box 26901, Oklahoma City, OK 73190
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13
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Singh S, Tripathy MP, Mohanty BB, Biswas S. Sporadic Multicentric Right Atrial and Right Ventricular Myxoma Presenting as Acute Pulmonary Thromboembolism. Heart Views 2016; 17:19-22. [PMID: 27293525 PMCID: PMC4879800 DOI: 10.4103/1995-705x.182642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Multicentric cardiac myxoma is a rare syndrome; usually it is familial. We report a rare case of sporadic right atrium (RA) and right ventricle (RV) myxoma in a 26-year-old female presenting to our hospital for the evaluation of sudden onset of dyspnea and left precordial pain attributed to the embolization of degenerating tumor fragments to the pulmonary artery (PA). The exact incidence of sporadic multicentric RA and RV myxoma presenting as acute pulmonary embolism is unknown as multicentric RA and RV myxoma are very rare. Myxomas presenting as pulmonary embolism is <10%. Majority of cardiac myxomas present as exertional dyspnea, chest pain, positional syncope, fever, weight loss and other constitutional symptoms. Any young patient presenting with acute onset dyspnea with multiple cardiac masses may have tumor embolization to the PA diagnosis with transthoracic echocardiography and high-resolution computed tomography of thorax, fast-tracks patient transfer for urgent cardiac surgery to prevent further embolization.
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Affiliation(s)
- Satyajit Singh
- Department of Cardiology, CARE Hospital, Bhubaneswar, Odisha, India
| | | | - Bipin Bihari Mohanty
- Department of Cardio-thoracic and Vascular Surgery, CARE Hospital, Bhubaneswar, Odisha, India
| | - Sutapa Biswas
- Department of Pathology, CARE Hospital, Bhubaneswar, Odisha, India
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14
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Mohan B, Chhabra ST, Gulati A, Mohan Mittal C, Mohan G, Tandon R, Kumbkarni S, Aslam N, Sood NK, Wander GS. Clinical and echocardiographic diagnosis, follow up and management of right-sided cardiac thrombi. Indian Heart J 2015; 65:529-35. [PMID: 24206876 DOI: 10.1016/j.ihj.2013.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/08/2013] [Accepted: 08/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Right-sided cardiac masses are infrequent and have varied clinical presentation. The present study describes the clinical features, echocardiographic findings and management of 19 patients presenting with right-sided cardiac thrombi in a tertiary care center in north India. METHODS This is a retrospective, single center observational study of consecutive patients over the period January 2003-2008 admitted in our emergency intensive care unit (EICU). We identified 38 patients with right-sided cardiac masses admitted to EICU diagnosed by transthoracic echocardiography of which 19 patients had right-sided thrombus. The echocardiographic findings were reviewed by two cardiologists in all patients. Treatment was not standardized and choice of therapy was based on judgment of attending physician. RESULTS The mean age of patients with cardiac thrombus was 36.6 ± 11.8 years. Right atrial (n = 17) and right ventricle (n = 2) thrombi were associated with deep vein thrombosis (DVT) in 7 (36.8%) and pulmonary embolism in 3 (15%) patients. 13 (68.4%) patients appeared to have in situ mural thrombus. 12 patients were managed with oral anticoagulants, 3 patients underwent surgery and 4 patients were thrombolysed. All the survivors had a mean follow-up of 40 ± 6 months (range--18-50 months). CONCLUSIONS Prompt echocardiographic examination in an appropriate clinical setting facilitates faster diagnosis and management of patients with right-sided cardiac thrombi. High incidence of in situ mural thrombus and varied comorbidities predisposing to right-sided cardiac thrombi besides DVT and pulmonary embolism need to be recognized. Oral anticoagulation and thrombolysis appear to be the mainstay of treatment with surgery limited for selected patients.
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Affiliation(s)
- Bishav Mohan
- Department of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India.
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15
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Naeem K. Floating thrombus in the right heart associated with pulmonary embolism: The role of echocardiography. Pak J Med Sci 2015; 31:233-5. [PMID: 25878652 PMCID: PMC4386195 DOI: 10.12669/pjms.311.6219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/05/2014] [Accepted: 11/08/2014] [Indexed: 11/16/2022] Open
Abstract
Free-floating right heart thrombi are rare and usually represent travelling clots from venous system to the lung. Almost exclusively, they are associated with pulmonary embolism. Despite associated high mortality, they are frequently under-diagnosed. We report a case of bilateral pulmonary embolism which was found to have a free-floating right atrial thrombus on echocardiography. The case, therefore, highlights the importance of echocardiography as a key examination in this setting. It can be performed at bedside to directly visualize the thrombi, assess and monitor right ventricular (RV) function, and help in making treatment decisions.
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Affiliation(s)
- Kashif Naeem
- Kashif Naeem, MRCP(UK), Department of Cardiology, Al Baraha Hospital, Dubai, UAE
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16
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Bodian M, Ba FG, Jobe M, Ndiaye MB, Kane A, Sarr SA, Mbaye A, Gaye AM, Thiam I, Diao M, Sarr M, Bâ SA. Fatal evolution of a huge right atrial free-floating thrombus. Clin Case Rep 2014; 1:63-5. [PMID: 25356214 PMCID: PMC4184751 DOI: 10.1002/ccr3.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 09/22/2013] [Accepted: 10/10/2013] [Indexed: 11/18/2022] Open
Abstract
Key Clinical Message Right atrial thrombus is a rare medical emergency that should be suspected in all cases of pulmonary embolism, and rapid action should be taken to ensure a timely, proper management.
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Affiliation(s)
- Malick Bodian
- Service de cardiologie, CHU Aristide Le Dantec Dakar, Senegal
| | - Fatimata G Ba
- Service de cardiologie, CHU Aristide Le Dantec Dakar, Senegal
| | - Modou Jobe
- Service de cardiologie, CHU Aristide Le Dantec Dakar, Senegal
| | | | - Adama Kane
- Service de cardiologie, CHU Aristide Le Dantec Dakar, Senegal
| | - Simon A Sarr
- Service de cardiologie, CHU Aristide Le Dantec Dakar, Senegal
| | - Alassane Mbaye
- Service de cardiologie, Hôpital General de Grand Yoff Dakar, Senegal
| | - Abdou M Gaye
- Service d'anatomie et de cytologie pathologiques, CHU Aristide Le Dantec Dakar, Senegal
| | - Ibou Thiam
- Service d'anatomie et de cytologie pathologiques, CHU Aristide Le Dantec Dakar, Senegal
| | - Maboury Diao
- Service de cardiologie, CHU Aristide Le Dantec Dakar, Senegal
| | - Moustapha Sarr
- Service de cardiologie, CHU Aristide Le Dantec Dakar, Senegal
| | - Serigne A Bâ
- Service de cardiologie, CHU Aristide Le Dantec Dakar, Senegal
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Gošev I, Paić F, Đurić Ž, Gošev M, Ivčević S, Jakuš FB, Biočina B. Cardiac myxoma the great imitators: Comprehensive histopathological and molecular approach. Int J Cardiol 2013; 164:7-20. [DOI: 10.1016/j.ijcard.2011.12.052] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 12/17/2011] [Indexed: 12/18/2022]
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18
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Hisatomi K, Yamada T, Onohara D. Surgical Embolectomy of a Floating Right Heart Thrombus and Acute Massive Pulmonary Embolism: Report of a Case. Ann Thorac Cardiovasc Surg 2013. [DOI: 10.5761/atcs.cr.12.01987] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Mueller KAL, Mueller II, Weig HJ, Doernberger V, Gawaz M. Thrombolysis is an appropriate treatment in lead-associated infective endocarditis with giant vegetations located on the right atrial lead. BMJ Case Rep 2012; 2012:bcr.09.2011.4855. [PMID: 22707697 DOI: 10.1136/bcr.09.2011.4855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CD endocarditis is a potentially lethal complication after implantation of permanent pacemakers or implantable cardioverter-defibrillators. Complete extraction of the hardware along with antibiotic treatment is the standard therapy. However, there is no standard procedure in the treatment of lead-associated infective endocarditis with large thrombotic vegetations. The authors present the case of a 60-year-old patient with a large vegetation located on the right atrial lead. Due to a high surgical and thrombembolic risk, especially of acute massive pulmonary embolism, the patient received recombinant tissue plasminogen activator to dissolve the thrombus under echocardiographic monitoring. The thrombotic masses were substantially reduced after thrombolysis. Therefore, standard transvenous extraction of the leads could be performed and high risk cardiac re-operation could be avoided.
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20
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Lasa JJ, Westover T, Khandelwal M, Cohen MS. Cor triatriatum dexter and right ventricular hypoplasia in a fetus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1744-1747. [PMID: 22124011 DOI: 10.7863/jum.2011.30.12.1744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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21
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Conradi L, Deuse T, Treede H, Seiffert M, Adam M, Koelble K, Costard-Jaeckle A, Wagner FM, Reichenspurner H. Minimally invasive resection of a right atrial mass in a cardiac transplant recipient: a case report. Transplant Proc 2011; 43:2059-62. [PMID: 21693325 DOI: 10.1016/j.transproceed.2010.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 10/29/2010] [Accepted: 11/03/2010] [Indexed: 11/18/2022]
Abstract
Intracardiac thrombus formation usually occurs in the left-sided cavities of the heart, most frequently in the presence of atrial fibrillation or cardiomyopathy. We report the case of an initially unclear mass developing in the right atrium (RA) of a heart transplant recipient, which was subsequently resected via a minimally invasive surgical approach. Access via right anterior minithoracotomy using videoscopic assistance allowed for uncomplicated RA thrombectomy in the presented case, avoiding reentry sternotomy with the potential risk of cardiac injury and without aortic cross-clamping or cardioplegic arrest. The patient is doing fine with excellent graft function at the latest follow-up 4 months after minimally invasive thrombectomy and 30 months after cardiac transplantation. To the best of our knowledge, this is the first report describing minimally invasive resection of a right atrial thrombus in a heart transplant recipient.
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Affiliation(s)
- L Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
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22
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Right atrial thrombus resembling myxoma. Int J Angiol 2011. [DOI: 10.1007/bf01618375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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23
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Zuzana M, Petr W, Dana B, Martin P, Hana L, Dana K, Miroslav K, Ludmila K, Jan K. An embolus in the right atrium caught in the Chiari network and resistant to thrombolysis. BMJ Case Rep 2010; 2010:bcr.09.2008.1019. [PMID: 22791494 DOI: 10.1136/bcr.09.2008.1019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case report describes a patient with thromboemboli trapped in the Chiari network within the right side of the heart and resistant to thrombolysis. The right atrial masses were completely removed under cardiopulmonary bypass. Histological evaluation confirmed a mixed thromboemboli, with thrombus structures showing signs of organisation and surrounded by a fibrous capsule. The plasma level of the plasminogen activator inhibitor type-1 (PAI-1) was 50% higher than the normal upper limit. In this presented case, the Chiari network displayed a protective function but the expansion and organisation of the thromboembolus found there made it resistant to lytic treatment. Another important factor that could have influenced the resistance to thrombolysis was the high level of PAI-1.
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Affiliation(s)
- Motovska Zuzana
- Third Medical Faculty of Charles University, Prague, Czech Republic.
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24
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Cho HJ, Seol SH, Choi BJ, Park SH, Kim DK, Kim U, Yang TH, Kim DK, Kim DI, Kim DS. A case of a right atrial and inferior vena caval thrombus resembling a right atrial myxoma. J Cardiovasc Ultrasound 2010; 18:58-61. [PMID: 20706571 DOI: 10.4250/jcu.2010.18.2.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 03/26/2010] [Accepted: 05/18/2010] [Indexed: 11/22/2022] Open
Abstract
A right atrial and inferior vena caval thrombus in a structurally normal heart is a very rare condition. We report a case of such a thrombus in a 66-year-old woman. She was admitted to our hospital with recent onset dyspnea. Based on echocardiography, we suspected that she had myxoma. We performed an excision of a mass, which was found, by pathologic examination, to be an organized mural thrombus.
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Affiliation(s)
- Hwan-Jin Cho
- Division of Cardiology, Department of Internal Medicine, Ulsan Hospital, Ulsan, Korea
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25
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Matsukuma S, Yamaguchi H, Hamawaki M. Floating and entangled long right atrial thrombus mimicking myxoma. J Echocardiogr 2010; 8:146-7. [PMID: 27278953 DOI: 10.1007/s12574-010-0050-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 05/01/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Seiji Matsukuma
- Department of Cardiovascular Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan.
| | - Hiroshi Yamaguchi
- Department of Cardiovascular Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Masayoshi Hamawaki
- Department of Cardiovascular Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
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26
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An embolus in the right atrium caught in the Chiari network and resistant to thrombolysis. J Thromb Thrombolysis 2009; 30:114-8. [DOI: 10.1007/s11239-009-0403-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Theologou T, Tewari P, Pointon K, Mitchell IM. Pulmonary Thromboembolism With Floating Thrombus Trapped in Patent Foramen Ovale. Ann Thorac Surg 2007; 84:2104-6. [DOI: 10.1016/j.athoracsur.2007.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 05/23/2007] [Accepted: 06/05/2007] [Indexed: 11/26/2022]
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28
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Pang G, Donaldson A. Probable right atrial thrombus immediately after recombinant activated factor VII administration. Br J Anaesth 2007; 99:221-5. [PMID: 17522107 DOI: 10.1093/bja/aem099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We report the finding of a probable right atrial thrombus in a 33-yr-old male patient with severe head, chest, and abdominal trauma. Refractory coagulopathy and gross haemodynamic instability ensued, which was only partially controlled with massive blood product transfusion and high-dose inotropic support during laparotomy. Continuous transoesophageal echocardiography revealed a probable atrial thrombus partially occluding the right ventricular inflow tract, which appeared immediately after the patient received 100 microg kg(-1) of recombinant activated factor VII (rFVIIa) via a left internal jugular central line. This is the first report documenting an immediate temporal relationship between rFVIIa administration and a space-occupying lesion compatible with localized thrombosis, despite ongoing severe systemic coagulopathy. We review the clinical use of rFVIIa and discuss possible factors contributing to this event.
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Affiliation(s)
- G Pang
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, Queensland 4006, Australia.
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29
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Lotto AA, Earl UM, Owens WA. Right atrial mass: Thrombus, myxoma, or cardiac papillary fibroelastoma? J Thorac Cardiovasc Surg 2006; 132:159-60. [PMID: 16798321 DOI: 10.1016/j.jtcvs.2006.03.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 03/15/2006] [Indexed: 11/27/2022]
Affiliation(s)
- Attilio A Lotto
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
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30
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Abstract
Right atrial (RA) masses are rare entities often detected incidentally during imaging studies. Leading etiologies of right atrial masses are tumor, thrombi, and vegetations. We present two cases of right atrial masses, a cardiac lipoma and an artifact. Clinical and echocardiographic characteristics of benign cardiac tumors are reviewed. We then highlight the importance of considering artifact in the differential diagnosis of atrial masses. Finally, we discuss echocardiographic characteristics of right atrial masses that may provide clues for diagnosis. Right atrial masses, often detected incidentally during imaging studies, are uncommon and can be due to many etiologies including tumors, thrombus, vegetations, normal variants, and artifacts. We describe 2 patients with RA masses detected on routine transthoracic echocardiogram.
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Affiliation(s)
- Michael S Chen
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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31
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Abstract
Primary tumors of the heart are rare with an incidence of 0.0017% to 0.19% in unselected patients at autopsy. Of those tumors, cardiac myxomas are the most commonly seen and account for about 50% of primary cardiac tumors. About 75% to 85% of myxomas originate in the left atrium, 15% to 20% in the right atrium, and only rare cases have been reported of myxomas originating in the left and right ventricles (5%). We present 3 cases in which right-sided myxomas were diagnosed echocardiographically and review the literature on primary cardiac myxomas.
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Affiliation(s)
- Sumit Mittle
- Division of Cardiology, North Shore University Hospital, Manhasset, New York 11030, USA
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32
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Pierre-Justin G, Pierard LA. Management of mobile right heart thrombi: a prospective series. Int J Cardiol 2005; 99:381-8. [PMID: 15771917 DOI: 10.1016/j.ijcard.2003.10.071] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2003] [Revised: 08/28/2003] [Accepted: 10/12/2003] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mobile right heart thrombi (MRHT) are uncommon but their true prevalence is unknown. The aim of our study was to assess the prevalence of MRHT by a systemic use of transthoracic echocardiography in a prospective series of consecutive patients admitted for acute severe pulmonary embolism (PE) and to adopt intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) as the first line intention to treat patients with proven MRHT. METHODS AND RESULTS We performed a systematic transthoracic echocardiogram from November 1997 to June 1999 in 335 consecutive patients admitted for suspected acute massive PE in whom the diagnosis was subsequently confirmed by perfusion lung scan or angiography. MRHT was identified in 12 of the 335 patients (4%). Nine patients presented a coil form and three patients a ball form. The thrombolytic employed in all cases was rt-PA according to the following protocol: 10 mg in a bolus and 40 mg over 2 h, followed by 50 mg over 5 h, up in a total dose of 100 mg, associated with a bolus of 5000 units of heparin. Control echocardiograms were performed 12 h after the initiation of treatment and at 12-month follow-up. Three patients died before the onset of thrombolytic infusion. The nine remaining patients were submitted to thrombolytic therapy using rt-PA. In seven of the nine remaining patients, MRHT was no longer observed after 12 h and the echocardiographic signs of RV overload had disappeared. The two last patients required adjunctive surgery because of evidence of persistent thrombus in a pulmonary artery. After 24 h, both scintigraphy and angiography demonstrated improved pulmonary perfusion. At 1-year follow-up, all patients were alive and the pulmonary artery pressure estimated by Doppler echocardiography was <30 mm Hg. CONCLUSIONS The incidence of right heart thrombus is low in patients admitted for acute PE. Thrombolytic therapy with rt-PA appears to be rapidly effective in most patients with MRHT. The thrombus usually resolves and pulmonary perfusion is rapidly improved. Systematic echocardiogram appears to be useful for rapidly detecting MRHT in patients with suspected massive PE.
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Affiliation(s)
- Gilbert Pierre-Justin
- University of Fort de France, Department of Cardiology, 97200 Fort De France, Martinique, France.
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33
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Embolismo pulmonar de origen cardíaco. Rev Clin Esp 2004. [DOI: 10.1016/s0014-2565(04)71458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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34
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Meng Q, Lai H, Lima J, Tong W, Qian Y, Lai S. Echocardiographic and pathologic characteristics of primary cardiac tumors: a study of 149 cases. Int J Cardiol 2002; 84:69-75. [PMID: 12104067 DOI: 10.1016/s0167-5273(02)00136-5] [Citation(s) in RCA: 200] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
To investigate the characteristics and pathological features of primary cardiac tumors and to evaluate the diagnostic sensitivity of echocardiography in primary cardiac tumors, all pathologic and echocardiographic records at the Chinese PLA general hospital and its satellite hospitals between January 1st, 1990 and January 1st, 2000 were reviewed to identify patients with a confirmed diagnosis of primary cardiac tumors. A total of 149 patients who had complete echocardiographic records and who were diagnosed with primary cardiac tumors were included in the study. Pathologic and echocardiographic records were reviewed retrospectively to evaluate the presence, location and histologic type of the tumors. The majority (n=118, 79.2%) of cases had been diagnosed with benign tumors. Myxoma was the most common histologic type accounting for 50.0% of total cardiac tumors. Lipoma was the second most common type of benign tumor. Among cases with malignant tumors (n=31, 20.8%), unclassified sarcoma (n=7), angiosarcoma (n=6) and rhabdomyosarcoma (n=6) were the common histologic types of primary malignant tumor. Non-myxomatous benign tumors were more likely to have occurred in the ventricle than myxomas (17/43, 39.5% vs. 7/75, 9.3%; P=0.00). The proportion of pericardium involvement in the malignant tumors (8/31, 25.8%) was significantly higher than that in the myxomas (0/75, 0%; P=0.00) and non-myxomas (2/43, 4.7%; P=0.01). The diagnostic sensitivity of transthoracic and transesophageal echocardiography was 93.3% (139/149) and 96.8% (30/31), respectively. The study, using a relatively large sample, confirms that myxoma was the most common primary cardiac tumor. The locations of tumor involvement varied by types of tumor. Echocardiography may be a useful tool for early diagnosis of primary cardiac tumors.
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Affiliation(s)
- Qingyi Meng
- Department of Emergency Medicine, Chinese PLA General Hospital, Beijing, PR China
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35
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Jiménez-Navarro MF, Carlos Gavilán J, María Melero J, Rodríguez Bailón I, Bermúdez F, Porras C, Olalla E, de Teresa E. [Large myxoma of the right atrium]. Rev Esp Cardiol 2001; 54:399-401. [PMID: 11262379 DOI: 10.1016/s0300-8932(01)76320-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the case of a patient in whom two-dimensional echocardiography, performed due to dissociated cholestasis and jugular ingurgitation, demonstrated a huge mass in the right atrium which prolapsed in the right ventricle. Intraoperative transesophageal echocardiography was performed to further assess the dimension and characteristics of the mass and to discard the involvement of associated structures. The patient underwent a cardiopulmonary bypass surgery and the mass (12 * 5 cm) was removed without complications. Histologic examination confirmed the diagnosis of myxoma. This case is of interest because of the size of the mass, and is centered in the diagnosis following clinical suspicion due to the pattern of dissociated cholestasis and jugular ingurgitation leading to surgery to prevent the potential embolic complications.
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Affiliation(s)
- M F Jiménez-Navarro
- Servicio de CardiologíaUnidad de Hepatitis, Servicio de Medicina Interna, Malaga.
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36
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Horton C, Wanat FE, Nekkanti R, Nanda NC. Tricuspid valve fibroelastoma in an elderly patient: transesophageal echocardiographic diagnosis and differentiation from a myxoma. THE AMERICAN JOURNAL OF GERIATRIC CARDIOLOGY 2001; 10:55-8. [PMID: 11413937 DOI: 10.1111/j.1076-7460.2001.90857.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Horton
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35249, USA
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37
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Bowman AR, Siegel RJ, Blanche C, Petrovic LM, Dhar S, Miller BJ, Kaul S. Metastatic pancreatic adenocarcinoma to the heart diagnosed antemortem. J Am Soc Echocardiogr 2000; 13:415-6. [PMID: 10804441 DOI: 10.1016/s0894-7317(00)70013-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pancreatic tumors frequently metastasize widely, though it is rare to diagnose pancreatic cardiac metastases in the antemortem state. We report an unusual case of metastatic pancreatic adenocarcinoma to the right atrium. Transesophageal echocardiography showed that the tumor was attached to the superior aspect of the right atrium, prolapsing through and obstructing the tricuspid valve in diastole and retracting back into the right atrium during systole. The tumor was excised, and histologic examination confirmed the presence of moderately differentiated adenocarcinoma with a papillary architectural pattern and with desmoplastic stroma, features comparable to the original primary pancreatic neoplasm.
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Affiliation(s)
- A R Bowman
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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38
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Brodmann M, Stark G, Pabst E, Lueger A, Pilger E. Pulmonary embolism and intracardiac thrombi--individual therapeutic procedures. Vasc Med 2000; 5:27-31. [PMID: 10737153 DOI: 10.1177/1358836x0000500105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mobile right heart thrombus is a severe but rare presentation of thromboembolic disease and usually coexists with an already massive pulmonary embolism (PE). But looking at the literature there is no clear consensus on therapeutic management. We therefore tried to find possible therapeutic guidelines and to evaluate an optimal diagnostic procedure looking at three patients who presented at our department with mobile right heart thrombus in the last year. The first patient with a small (diameter = 1 cm) thrombus in the right ventricle and peripheral pulmonary embolism underwent successful thrombolytic therapy without any complications. Patients II and III showed large intracardiac masses, in patient III extending into the superior vena cava, with central PE. These two patients underwent pulmonary arteriotomy. The diagnostic line in each case was transthoracal echocardiography followed by a helix lung CT scan. Only patients with small intracardiac thrombi and thrombotic masses in the peripheral pulmonary arteries but with hemodynamically significant PE should be treated with thrombolytic agents.
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Affiliation(s)
- M Brodmann
- Department of Internal Medicine, Karl-Franzens University Graz, Austria
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39
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Inoue T, Otaki M, Ku K, Saga T, Oku H. Right Atrial Pedunculated Ball Thrombus. Asian Cardiovasc Thorac Ann 1999. [DOI: 10.1177/021849239900700316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Two rare cases of right atrial pedunculated ball thrombus associated with constrictive pericarditis and systemic lupus erythematosus are reported. Under cardiopulmonary bypass, the large thrombus in each patient was removed with care to avoid pulmonary embolism. Both patients have been doing well postoperatively and warfarin has been administered to prevent a recurrence of intracardiac thrombotic episodes.
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Affiliation(s)
- Takehiro Inoue
- Department of Cardiovascular Surgery Kinki University School of Medicine Osaka, Japan
| | - Masaki Otaki
- Department of Cardiovascular Surgery Kinki University School of Medicine Osaka, Japan
| | - Kwansong Ku
- Department of Cardiovascular Surgery Kinki University School of Medicine Osaka, Japan
| | - Tosihiko Saga
- Department of Cardiovascular Surgery Kinki University School of Medicine Osaka, Japan
| | - Hidetaka Oku
- Department of Cardiovascular Surgery Kinki University School of Medicine Osaka, Japan
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40
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Chartier L, Béra J, Delomez M, Asseman P, Beregi JP, Bauchart JJ, Warembourg H, Théry C. Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients. Circulation 1999; 99:2779-83. [PMID: 10351972 DOI: 10.1161/01.cir.99.21.2779] [Citation(s) in RCA: 294] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Floating right heart thrombi (FRHTS) are a rare phenomenon, encountered almost exclusively in patients with suspected or proven pulmonary embolism and diagnosed by transthoracic echocardiography. Their management remains controversial. METHODS AND RESULTS We report on a series of 38 consecutive patients encountered over the past 12 years. Thirty-two patients were in NYHA class IV, 20 in cardiogenic shock. Echocardiography usually demonstrated signs of cor pulmonale: right ventricular overload (91.7% of the population), paradoxical interventricular septal motion (75%), and pulmonary hypertension (86. 1%). The thrombus was typically wormlike (36 of 38 patients). It extended from the left atrium through a patent foramen ovale in 4 patients. Pulmonary embolism was confirmed in all but 1. Mortality was high (17 of 38 patients) irrespective of the therapeutic option chosen: surgery (8 of 17), thrombolytics (2 of 9), heparin (5 of 8), or interventional percutaneous techniques (2 of 4). The in-hospital mortality rate was significantly linked with the occurrence of cardiac arrest. Conversely, the outcome after discharge was usually good, because 18 of 21 patients were still alive 47.2 months later (range, 1 to 70 months). CONCLUSIONS Severe pulmonary embolism was the rule in our series of FRHTS (mortality rate, 44.7%). The choice of therapy had no effect on mortality. Emergency surgery is usually advocated. However, thrombolysis is a faster, readily available treatment and seems promising either as the only treatment or as a bridge to surgery. In patients with contraindications to surgery or lytic therapy, interventional techniques may be proposed.
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Affiliation(s)
- L Chartier
- Service de Soins Intensifs Médicaux et de Réanimation Cardiaque, Service de Radiologie Vasculaire, Lille, France
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41
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Yoshitomi Y, Kojima S, Sugi T, Matsumoto Y, Yano M, Ozeki Y, Kuramochi M. Echocardiography of a right atrial mass in hepatocellular carcinoma. Heart Vessels 1999; 13:45-8. [PMID: 9923565 DOI: 10.1007/bf02750643] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antemortem diagnosis of hepatocellular carcinoma with a tumor thrombus extending into the right atrium has been rarely observed. Although echocardiography allows easy detection of the intracardiac mass, reports of echocardiographic descriptions of a right atrial mass associated with hepatocellular carcinoma are few. Herein, we describe two cases of hepatocellular carcinoma with a tumor thrombus in the right atrium detected by transthoracic echocardiography. In one of the patients we also performed transesophageal echocardiography. Neither patient had cardiac symptoms or signs. Thus, echocardiographic examination is very important in patients with hepatocellular carcinoma, with or without cardiac symptoms and signs.
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Affiliation(s)
- Y Yoshitomi
- Division of Cardiology, Tohsei National Hospital, Shizuoka, Japan
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42
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Schwartzbard AZ, Tunick PA, Rosenzweig BP, Kronzon I. The role of transesophageal echocardiography in the diagnosis and treatment of right atrial thrombi. J Am Soc Echocardiogr 1999; 12:64-9. [PMID: 9882780 DOI: 10.1016/s0894-7317(99)70174-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty patients with right atrial thrombi were identified through the use of transthoracic and transesophageal echocardiography. Transesophageal echocardiography identified right atrial thrombi in all 20 cases. Transthoracic echocardiography showed definite thrombi in only 6 (30%) cases and suggested thrombus in another 2 (10%) patients. Thus transthoracic echocardiography results were false-negative for right atrial thrombus in 60% of cases. All 3 thrombi found within the right atrial appendage and 2 of 3 thrombi on pacemaker wires were missed by transthoracic echocardiography. There was no significant difference in the mean size between those thrombi seen (1.37 +/- 0.6 cm) and those missed (1.5 +/- 0.9 cm) by transthoracic echocardiography. Transesophageal echocardiography also significantly affected treatment. Anticoagulation was initiated or amplified in 13 patients. In 8 of these 13, thrombi were seen only by transesophageal echocardiography. Surgery was performed to remove thrombi in 7 cases, and in 3 (43%) cases it was because of thrombi seen only by transesophageal echocardiography. This study suggests that transesophageal echocardiography should be performed whenever right atrial thrombi are suspected. Transesophageal echocardiography has a significant effect on the diagnosis and management of patients with right atrial thrombi.
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Affiliation(s)
- A Z Schwartzbard
- Charles and Rose Wohlstetter Noninvasive Cardiology Laboratory, Department of Medicine, New York University Medical Center, New York, NY 10016, USA
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43
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Economides EG, Singh A. Case of tumor neovascularization demonstrated by cardiac catheterization. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 43:451-3. [PMID: 9554777 DOI: 10.1002/(sici)1097-0304(199804)43:4<451::aid-ccd21>3.0.co;2-l] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A 46-year-old man presented to his physician with nonspecific abdominal complaints. CT of the abdomen was obtained to investigate his symptoms, which showed significant pericardial effusion. One week after drainage of the pericardial fluid, his symptoms recurred and a transesophageal echo showed a right atrial tumor. Cardiac catheterization demonstrated right coronary artery neovascularization. A nonresectable primary angiosarcoma was found following median sternotomy and biopsy.
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Affiliation(s)
- E G Economides
- Department of Internal Medicine, Albany Medical Center, New York, USA.
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44
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Gilon D, Schechter D, Rein AJ, Gimmon Z, Or R, Rozenman Y, Slavin S, Gotsman MS, Nagler A. Right atrial thrombi are related to indwelling central venous catheter position: insights into time course and possible mechanism of formation. Am Heart J 1998; 135:457-62. [PMID: 9506332 DOI: 10.1016/s0002-8703(98)70322-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We studied the effect of central line catheters on thrombus formation in the right atrium (RA), including the incidence and echocardiographic characteristics of the catheter-associated thrombus as well as possible clinical implications in patients. We prospectively studied 55 patients by transesophageal echocardiography within 1 week after Hickman catheter implantation and on a follow-up study at 6 to 8 weeks. We succeeded in imaging the catheter tip in 48 of the 55 patients (87%). In the baseline study 13 had the tip placed in the RA, eight at the superior vena cava-atrium junction, and 27 in the superior vena cava. An abnormal mass, consistent with a thrombus, was found in 12.5% of the patients, all of which were seen within the 13-patient (46%) group with the Hickman catheter tip placed in the RA. Hickman catheter insertion is associated with high incidence (12.5%) of early formation of RA thrombus. The formation of these thrombi is asymptomatic and highly associated (p < 0.001) with the catheter tip position in the RA, in contrast to their positioning in the superior vena cava or in its junction with the right atrium. On the basis of these findings, we recommend that special attention and effort be given to placing of the catheter tip in the superior vena cava and avoiding the RA during the implantation procedure.
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Affiliation(s)
- D Gilon
- Department of Cardiology, Hadassah University Hospital, Jerusalem, Israel
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Ellis PK, Kidney DD, Deutsch LS. Giant right atrial thrombus: a life-threatening complication of long-term central venous access catheters. J Vasc Interv Radiol 1997; 8:865-8. [PMID: 9314380 DOI: 10.1016/s1051-0443(97)70675-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- P K Ellis
- University of California, Irvine Medical Center, Orange 92868, USA
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Line BR, Keenan JF, Lukasiewicz RL, Dansereau RN, Tublin ME, Williams LM, Gargan PE. Cardiopulmonary thromboembolism detected by Tc-99m MH-1 antifibrin antibody. Clin Nucl Med 1997; 22:376-9. [PMID: 9193807 DOI: 10.1097/00003072-199706000-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A patient with shortness of breath had a high probability lung scan for pulmonary embolism, but no obvious embolic source. Whole-body scintigraphy using Tc-99m labeled Fab' antifibrin monoclonal antibody showed large central pulmonary emboli as well as tracer uptake in the right atrium and aortic arch. No lower extremity clot was detected. This case shows significant differences in the appearance of pulmonary embolism as assessed by direct clot and ventilation-perfusion scintigraphy. It shows the importance of the heart as the origin of pulmonary emboli and the utility of direct thrombus visualization.
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Affiliation(s)
- B R Line
- Department of Radiology, Albany Medical College, Albany, New York, USA
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Shah CP, Thakur RK, Ip JH, Xie B, Guiraudon GM. Management of mobile right atrial thrombi: a therapeutic dilemma. J Card Surg 1996; 11:428-31. [PMID: 9083870 DOI: 10.1111/j.1540-8191.1996.tb00077.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mobile right atrial thrombus is an uncommon finding on two-dimensional (2D) echocardiography. Therapeutic alternatives include systemic heparinization, systemic or local thrombolysis, and surgical removal. We report our clinical experience in six patients over a 3-year period (6000 echocardiograms) at a tertiary care referral center. METHODS There were four men and two women with a mean age of 63 years (range: 47 to 73 years). Indications for echocardiography consisted of progressive dyspnea and chest pain in five patients and syncope with chest pain in one patient. RESULTS All were observed to have a mobile thrombus in the right atrium. Ventilation perfusion (V/Q) scanning confirmed V/Q mismatch in all patients. Subsequent echocardiography (minutes to 1 day later) in three patients demonstrated absence of the thrombus suggesting pulmonary embolization. One patient died during transesophageal echocardiography (TEE) and autopsy confirmed a large pulmonary embolization in the main pulmonary artery. Treatment consisted of heparinization in 3 patients, systemic thrombolysis in 1 patient, and surgical removal of the thrombus in 1 patient. At surgery, a long serpiginous thrombus was seen in the right atrium, tethered to a fenestrated eustachian valve. There were 3 deaths: 1 patient treated with heparin; 1 patient treated with thrombolysis; and 1 during TEE. Two of the three patients treated with heparin and one patient undergoing surgical removal survived hospitalization. CONCLUSIONS Mobile thrombus in the right atrium is an unusual echocardiographic finding. It portends a poor prognosis with death due to pulmonary embolism.
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Affiliation(s)
- C P Shah
- Division of Cardiology and Cardiac Surgery, University Hospital, London, Canada
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Affiliation(s)
- J M Rankin
- Cardiology Department, Royal Perth Hospital, Western Australia, 6009
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Abstract
Although cardiac myxomas are histologically benign, they may be lethal because of their strategic position. They can mimic not only every cardiac disease but also infective, immunologic, and malignant processes. Myxomas must therefore be included in the differential diagnosis of valvular heart disease, cardiac insufficiency, cardiomegaly, bacterial endocarditis, disturbances of ventricular and supraventricular rhythm, syncope, and systemic or pulmonary embolism. The symptoms depend on the size, mobility, and location of the tumor. Echocardiography, including the transesophageal approach, is the most important means of diagnosis; CT and MRI may also be helpful. Coronary arteriography in patients over 40 years of age is generally required to rule out concomitant coronary artery disease. Surgical removal of the tumor should be performed as soon as possible; the long-term prognosis is excellent, and recurrences are rare. In follow-up examinations as well, echocardiography is essential.
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Affiliation(s)
- K Reynen
- Department of Internal Medicine II, University of Erlangen-Nürnberg, Germany
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Leibowitz G, Keller NM, Daniel WG, Freedberg RS, Tunick PA, Stottmeister C, Kronzon I. Transesophageal versus transthoracic echocardiography in the evaluation of right atrial tumors. Am Heart J 1995; 130:1224-7. [PMID: 7484773 DOI: 10.1016/0002-8703(95)90146-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to define the contribution of transesophageal echocardiography to the diagnosis of right atrial tumors in a large series of patients with this rare finding. Transesophageal echocardiography (TEE) has been found to be valuable in evaluating patients with intracardiac masses and has been shown to be superior to transthoracic echocardiography (TTE) in evaluating left heart masses. Between 1989 and 1993, 23 patients with either known tumors elsewhere or right atrial masses that were detected on TTE were evaluated with TEE. TEE studies were performed in the noninvasive cardiology laboratory. All patients were studied with 5 MHz biplane or omniplane transducers. The right atrium was evaluated for the presence, characteristics, extent, and attachment of any masses and for extension of these masses into the great vessels or other cardiac chambers. No complications occurred. Six patients had primary right atrial tumors. In 10 patients the tumors reached the right atrium via the inferior vena cava. Seven patients had malignant secondary tumors. TEE demonstrated three tumors not detected by TTE. Furthermore TEE provided 16 additional findings not seen on TTE. In conclusion, TEE is superior to TTE in the evaluation of right atrial tumors. TEE should be considered in patients with right atrial tumors even when these tumors have been demonstrated with TTE.
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Affiliation(s)
- G Leibowitz
- Charles and Rose Wohlstetter Noninvasive Cardiology Laboratory, Department of Medicine, New York University Medical Center, NY, USA
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