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Roldan CA, Moazez C, Yatskowitz J, Maoz-Metzl D, Castlemain B, Fischer E. Cor Triatriatum Dexter and Right Atrial Mass Causing Severe Inflow Obstruction. CASE (PHILADELPHIA, PA.) 2024; 8:286-291. [PMID: 38765628 PMCID: PMC11096656 DOI: 10.1016/j.case.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
•CTD and SLE with APS-associated thrombogenesis can lead to RA thrombi formation. •In CTD, a large inferior RA chamber thrombi can cause severe inflow obstruction. •TTE and TEE are essential in defining the hemodynamic impact of CTD and RA thrombi. •TEE is key in guiding successful surgical resection of CTD and RA thrombi.
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Affiliation(s)
- Carlos A. Roldan
- Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Carmel Moazez
- Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Jerome Yatskowitz
- Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Daniel Maoz-Metzl
- Division of Cardiothoracic Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Brian Castlemain
- Division of Cardiothoracic Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Edgar Fischer
- Division of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Yoshida T, Uemura A, Tanaka R, Farag A, Mandour AS, Hamabe L, Matsumoto K. Secondary right atrial thrombosis in three dogs: Antithrombotics therapy and echocardiographic follow-up. Vet Med Sci 2023; 9:1973-1979. [PMID: 37491011 PMCID: PMC10508537 DOI: 10.1002/vms3.1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/09/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023] Open
Abstract
Three dogs were diagnosed with right atrial thrombosis, thought to be secondary to systemic diseases. Specifically, two cases had hyperadrenocorticism and one case was diagnosed with pancreatitis with acute renal injury. In all cases, the thrombi were found within the right atrium, necessitating a differentiation from cardiac neoplasia. In all three cases, the structures assumed to be thrombi had irregular margins with interspersed hypoechoic regions, which were later confirmed as thrombi based on the responsiveness to therapy. All three cases were prescribed with the combination of clopidogrel and rivaroxaban.The thrombi gradually disappeared after initiation of the combination therapy. Complete resolution of right atrial thrombosis was noted in each dog treated with clopidogrel and rivaroxaban. This combination therapy appears to be safe and well tolerated. Diligent observation of the echocardiographic findings and clinical course allows the diagnosis of thrombosis.
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Affiliation(s)
- Tomohiko Yoshida
- Department of Clinical Veterinary MedicineObihiro University of Agriculture and Veterinary MedicineHokkaidoJapan
| | - Akiko Uemura
- Department of Clinical Veterinary MedicineObihiro University of Agriculture and Veterinary MedicineHokkaidoJapan
| | - Ryou Tanaka
- Department of Veterinary SurgeryTokyo University of Agriculture and TechnologyTokyoJapan
| | - Ahmed Farag
- Department of Veterinary SurgeryTokyo University of Agriculture and TechnologyTokyoJapan
- Faculty of Veterinary Medicine, Department of SurgeryAnesthesiology, and Radiology, Zagazig UniversityZagazigEgypt
| | - Ahmed S. Mandour
- Department of Veterinary SurgeryTokyo University of Agriculture and TechnologyTokyoJapan
- Faculty of Veterinary Medicine, Department of Animal Medicine (Internal Medicine)Suez Canal UniversityIsmailiaEgypt
| | - Lina Hamabe
- Department of Veterinary SurgeryTokyo University of Agriculture and TechnologyTokyoJapan
| | - Kotaro Matsumoto
- Department of Clinical Veterinary MedicineObihiro University of Agriculture and Veterinary MedicineHokkaidoJapan
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Song W, Wang Y, Ma X, Liu L, Gu Y, Sun Y, Zhao Y, Ye Y, Zhang Y. Dumbbell in the atrium: A rare case report of biatrial myxoma that crosses atrial septum diagnosed by multimodal echocardiography. Echocardiography 2022; 39:1620-1622. [PMID: 36349385 DOI: 10.1111/echo.15477] [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: 08/31/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022] Open
Abstract
We reported a very rare case, a 59-year-old female whose heart myxoma was present in both atrium, the mass in biatrial was connected to each other at the oval foramen, resembling "dumbbell-like." By means of multimodality echocardiography techniques such as transthoracic echocardiography (TTE), contrast enhanced ultrasound (CEUS), and Real-time three-dimensional transesophageal echocardiography (RT-3D TEE), we have clarified the diagnosis. The patient underwent open-heart surgery to remove the biatrial myxoma which adhered to the oval fossa, with a slightly wider base and smooth lobulated surface. This case demonstrates the importance of multimodality echocardiography in the diagnosis of atypical myxomas.
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Affiliation(s)
- Wenjuan Song
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Yu Wang
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Xuejuan Ma
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Liping Liu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Ying Gu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Yue Sun
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Yue Zhao
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Yujia Ye
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
| | - Ying Zhang
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan province, China
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Multimodality Imaging of Benign Primary Cardiac Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102543. [PMID: 36292232 PMCID: PMC9601182 DOI: 10.3390/diagnostics12102543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.
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Li Y, Ren W, Wang X, Xiao Y, Feng Y, Shi P, Sun L, Wang X, Yang H, Song G. The diagnostic accuracy of contrast echocardiography in patients with suspected cardiac masses: A preliminary multicenter, cross-sectional study. Front Cardiovasc Med 2022; 9:1011560. [PMID: 36187014 PMCID: PMC9523017 DOI: 10.3389/fcvm.2022.1011560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background To evaluate the diagnostic accuracy of contrast echocardiography (CE) in patients with suspected cardiac masses. Methods A multicenter, prospective study involving 108 consecutive patients with suspected cardiac masses based on transthoracic echocardiography performed between November 2019 and December 2020 was carried out. CE examinations were performed in all patients. The echocardiographic diagnosis was established according to the qualitative (echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility) and quantitative (area of the masses and peak intensity ratio of the masses and adjacent myocardium A1/A2) evaluations. Results Final confirmed diagnoses were as follows: no cardiac mass (n = 3), pseudomass (n = 3), thrombus (n = 36), benign tumor (n = 30), and malignant tumor (n = 36). ROC analysis revealed the optimal A1/A2 with cutoff value of 0.295 for a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.958 (95% confidence interval (CI): 0.899–0.988), 100, 91.7, 95.7, and 100%, respectively. CE was able to distinguish malignant from benign tumors with an AUC of 0.953 (95% CI: 0.870–0.990). Multivariate logistic regression analysis revealed that tumor area, base, and A1/A2 were associated with the risk of malignant tumor (OR = 1.003, 95% CI: 1.00003–1.005; OR = 22.64, 95% CI: 1.30–395.21; OR = 165.39, 95% CI: 4.68–5,850.94, respectively). When using A1/A2 > 1.28 as the only diagnostic criterion to identify the malignant tumor, AUC, sensitivity, specificity, PPV, and NPV were 0.886 (95% CI: 0.784–0.951), 80.6, 96.7, 96.7, and 80.7%, respectively. Conclusion CE has the potential to accurately differentiate cardiac masses by combining qualitative and quantitative analyses. However, more studies with a large sample size should be conducted to further confirm these findings. Clinical trial registration http://www.chictr.org.cn/, identifier: ChiCTR1900026809.
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Affiliation(s)
- Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yueqin Feng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Pengli Shi
- Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Lijuan Sun
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiao Wang
- Department of Ultrasound, Anshan Central Hospital, Anshan, China
| | - Huan Yang
- Department of Ultrasound, Yingkou Central Hospital, Yingkou, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Guang Song
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Gambril JA, Chum A, Goyal A, Ruz P, Mikrut K, Simonetti O, Dholiya H, Patel B, Addison D. Cardiovascular Imaging in Cardio-Oncology: The Role of Echocardiography and Cardiac MRI in Modern Cardio-Oncology. Heart Fail Clin 2022; 18:455-478. [PMID: 35718419 PMCID: PMC9280694 DOI: 10.1016/j.hfc.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cardiovascular (CV) events are an increasingly common limitation of effective anticancer therapy. Over the last decade imaging has become essential to patients receiving contemporary cancer therapy. Herein we discuss the current state of CV imaging in cardio-oncology. We also provide a practical apparatus for the use of imaging in everyday cardiovascular care of oncology patients to improve outcomes for those at risk for cardiotoxicity, or with established cardiovascular disease. Finally, we consider future directions in the field given the wave of new anticancer therapies.
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Affiliation(s)
- John Alan Gambril
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA; Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA. https://twitter.com/GambrilAlan
| | - Aaron Chum
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Akash Goyal
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA. https://twitter.com/agoyalMD
| | - Patrick Ruz
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Katarzyna Mikrut
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA. https://twitter.com/KatieMikrut
| | - Orlando Simonetti
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA; Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA; Department of Radiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Hardeep Dholiya
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA. https://twitter.com/Hardeep_10
| | - Brijesh Patel
- Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA; Cardio-Oncology Program, Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Azarine A, Scalbert F, Garçon P. Cardiac functional imaging. Presse Med 2022; 51:104119. [PMID: 35321846 DOI: 10.1016/j.lpm.2022.104119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 01/01/2023] Open
Abstract
During the last 20 years, cardiac imaging has drastically evolved. Positron emission tomography (PET), fast three-dimensional (3D) imaging with the latest generations of echocardiography & multi-detector computed tomography (CT), stress perfusion assessed by magnetic resonance imaging (MRI), blood flow analysis using four-dimensional (4D) flow MRI, all these techniques offer new trends for optimal noninvasive functional cardiac imaging. Dynamic functional imaging is obtained by acquiring images of the heart at different phases of the cardiac cycle, allowing assessment of cardiac motion, function, and perfusion. Between CT and Cardiac MRI (CMR), CMR has the best temporal resolution, which is suitable for functional imaging while cardiac CT provides higher spatial resolution with isotropic data that have an identical resolution in the three dimensions of the space. The latest generations of CT scanners enable whole heart assessment in one beat, offering also an acceptable temporal resolution with the possibility to display the images in a dynamic mode. Another rapidly growing technique using functional and molecular imaging for the assessment of biological and metabolic pathways is the PET using radio-labeled tracers. Meanwhile, the oldest cardiac imaging tool with doppler ultrasound technology has never stopped evolving. Echocardiography today performs 3D imaging, stress perfusion, and myocardial strain assessment, with high temporal resolution. It still is the first line and more accessible exam for the patient. These different modalities are complementary and may be even combined into PET-CT or PET-MRI. The ability to combine the functional/molecular data with anatomical images may implement a new dimension to our diagnostic tools.
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Affiliation(s)
- Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France.
| | - François Scalbert
- Nuclear Medecine Department, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877, Paris, France
| | - Philippe Garçon
- Cardiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
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Nishiori H, Hirano Y, Otsu M, Watanabe H. Large left atrial thrombus resection in a patient in sinus rhythm without mitral valve disease: A case report. Int J Surg Case Rep 2022; 94:107000. [PMID: 35405512 PMCID: PMC9006327 DOI: 10.1016/j.ijscr.2022.107000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Left atrial (LA) ball thrombi are often associated with atrial fibrillation (AF) and mitral valve disease (MVD). Differentiating between thrombi and LA tumors can be challenging. Presentation of a case A 63-year-old man with a prior mesh insertion for abdominal incisional hernia was admitted with fever. He was diagnosed with an abdominal mesh-related infection requiring surgical debridement. Preoperative transthoracic echocardiography revealed a 39-mm smooth mass in the LA adherent to the atrial septum. The mass was suspected to be a cardiac tumor based on the morphology. The patient underwent mass resection. Pathophysiology revealed that the mass was a thrombus, necessitating anticoagulation therapy. No recurrence of thrombus formation was reported. Discussion In this case, a plausible factor causing the thrombus formation is the chronic mesh. Since LA thrombi can become free-floating or grow rapidly, early surgical intervention is essential to prevent thrombotic events or sudden death. Conclusion An LA thrombus should be included in the differential diagnosis when an LA mass is detected. Prompt surgical resection prevents thrombotic events and improves patient outcomes. Causes of left atrial thrombus include mitral valve disease and atrial fibrillation. Left atrial thrombi can be difficult to differentiate from left atrial tumors. Large left atrial thrombi can become free-floating or grow rapidly. For large left atrial thrombi, prompt surgery is required.
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Affiliation(s)
- Hironobu Nishiori
- Division of Cardiovascular Surgery, Narita Red Cross Hospital, 90-1, Ida-Cho, Narita City 286-8523, Chiba, Japan.
| | - Yuichi Hirano
- Division of Cardiovascular Surgery, Narita Red Cross Hospital, 90-1, Ida-Cho, Narita City 286-8523, Chiba, Japan
| | - Masayoshi Otsu
- Division of Cardiovascular Surgery, Narita Red Cross Hospital, 90-1, Ida-Cho, Narita City 286-8523, Chiba, Japan
| | - Hiroyuki Watanabe
- Division of Cardiovascular Surgery, Narita Red Cross Hospital, 90-1, Ida-Cho, Narita City 286-8523, Chiba, Japan
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Niazi M, Khan D, Mustafa A, Munir AB, Karam B, Snyder ST, Lafferty J. Left Atrial Thrombus Mimicking Myxoma Secondary to Rebound Hypercoagulable State. J Med Cases 2021; 12:243-247. [PMID: 34434465 PMCID: PMC8383509 DOI: 10.14740/jmc3656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022] Open
Abstract
Novel oral anticoagulants (NOACs) have made the use of anticoagulation in patients with atrial fibrillation (AFib) much more convenient and predictable. It is a very common practice to hold anticoagulation either in anticipation of surgical procedures (to prevent excessive bleeding) or in case of acute bleeding episodes. This abrupt withdrawal of anticoagulation tilts the balance in favor of pro-thrombotic state in the body. We present a case of a 60-year-old man with past medical history of AFib who abruptly discontinued his apixaban (Eliquis). This patient presented to emergency room with the complaint of weakness and numbness of left arm and left half of the face. Stroke code was activated, and patient received tissue plasminogen activator (t-PA). This resulted in significant improvement of symptoms within hours of receiving treatment. Later during the same day, patient developed numbness and tingling of fingers of left hand. On physical exam, left hand was cold to touch and radial pulse was absent. Arterial duplex revealed occluded ulnar and radial arteries. Vascular surgery performed embolectomy to establish blood flow in the radial and ulnar arteries. Transthoracic echocardiogram revealed large left atrial mass attached to the atrial septum. Most likely t-PA infusion in the setting of atrial mass led to distal showering of emboli resulting in stenosis of radial and ulnar arteries. The left atrial mass was most likely thrombus as patient had cardiac imaging including transthoracic echocardiogram and computed tomography of heart prior to these events which did not reveal any mass in left atrium. In short, as clinicians we should be aware of the hypercoagulability associated with withdrawal of anticoagulation. In addition, we should be wary of the challenges associated with differentiating cardiac masses of different etiology.
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Affiliation(s)
- Muhammad Niazi
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave., Staten Island, NY 10305, USA
| | - Danyal Khan
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave., Staten Island, NY 10305, USA
| | - Ahmad Mustafa
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave., Staten Island, NY 10305, USA
| | - Abdullah B Munir
- Department of Cardiology, Staten Island University Hospital/Northwell Health, 475 Seaview Ave., Staten Island, NY 10305, USA
| | - Boutros Karam
- Department of Cardiology, Staten Island University Hospital/Northwell Health, 475 Seaview Ave., Staten Island, NY 10305, USA
| | - Stavros T Snyder
- Department of Cardiology, Staten Island University Hospital/Northwell Health, 475 Seaview Ave., Staten Island, NY 10305, USA
| | - James Lafferty
- Department of Cardiology, Staten Island University Hospital/Northwell Health, 475 Seaview Ave., Staten Island, NY 10305, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Li Y, Wang X, Ren W, Xiao Y, Yu X, Tan X. Cardiac thrombotic stability determined by contrast-enhanced echocardiography: investigative protocol and preliminary results. BMC Cardiovasc Disord 2021; 21:267. [PMID: 34058996 PMCID: PMC8167997 DOI: 10.1186/s12872-021-02085-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/27/2021] [Indexed: 11/11/2022] Open
Abstract
Objective This study’s intent was to test a new system for scoring cardiac thrombotic stability, based on contrast-enhanced ultrasound (CEUS). Methods We used human whole blood for an in vitro thrombotic model involving 1-h (T1h) and 7-day (T7d) subsets. The T1h group was monitored for 1 h continuously to observe for the formation of a new thrombus on the original thrombus base. Changes in thrombotic CEUS images, histologic features, and shear wave elastography were recorded over time. We also studied 28 patients diagnosed with cardiac thrombi, each examined by transthoracic echocardiography and CEUS.Thrombi were scored for substrate (Ts) and hardness (Th) based on the visualized degree of contrast penetration into the thrombi. Statistical analyses of Ts and Th reflected thrombolytic time and risk of embolism to other organs. Results Histologically, the loosely constructed ends of in vitro thrombi solidified over time. In addition, the average Young’s modulus of thrombi over time indicated a progressive increase in hardness. Contrast-enhancing agents were able to penetrate fresh, loose thrombi only, not chronic, stable thrombi. As Ts and Th increased, prolonged thrombolytic time and greater risk of embolism to other organs were apparent. Conclusions Our data suggest that this new CEUS scoring system correlates well with cardiac thrombotic hardness and the quality of its underlying substrate, serving to quantify thrombotic stability.
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Affiliation(s)
- Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China.
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
| | - Xiaona Yu
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
| | - Xueying Tan
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, 110004, China
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Coroyer L, Garcon P, Duchatelle V, Azarine A. Interventricular septum mass presenting as a late acute coronary syndrome with ST-segment elevation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab164. [PMID: 34124566 PMCID: PMC8189305 DOI: 10.1093/ehjcr/ytab164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/05/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
Background Intracardiac masses are relatively rare but the diagnosis can be challenging for the cardiologist and the clinical presentation can be misleading. While most of the cardiac masses are benign, malignant masses are mostly metastatic tumours. Case summary An 81-year-old man was admitted to the cardiology department for congestive heart failure with the complaint of recent dyspnoea. The initial electrocardiogram was suggestive of a late presentation of an anterior myocardial infarction. Blood test showed mild and stable elevation of troponin and brain natriuretic peptide. Doppler-echocardiography revealed an interventricular septal thickening. Contrast echocardiography revealed a mass with a possibly necrotic centre and peripheral hypervascularization. Cardiac computed tomography (CT) confirmed the existence of a cardiac tumour with a hypodense centre and also revealed the presence of a large tumour of the lung’s left lower lobe with multiple enlarged lymph nodes associated with possible left adrenal gland metastasis. Computed tomography-guided percutaneous biopsy of the pulmonary mass demonstrated a squamous cell lung cancer which was likely the primary cancer. The patient was discharged home waiting for chemotherapy to start but died a few days later at home of an unknown cause. Discussion Diagnosis of intracardiac mass is difficult, often requiring multiple imaging modalities. Contrast-enhanced echocardiography may help early diagnosis and can be easily implemented with other imaging modalities such as cardiac magnetic resonance imaging or CT.
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Affiliation(s)
- Lucas Coroyer
- Cardiology Department, Hopital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
| | - Philippe Garcon
- Cardiology Department, Hopital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
| | - Veronique Duchatelle
- Pathology Department, Hopital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
| | - Arshid Azarine
- Radiology Department, Hopital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
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12
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Durieux R, Tchana-Sato V, Lavigne JP, Radermecker MA, Moonen M, Scagnol I, Gennigens C, Defraigne JO. Recurrent cardiac intimal sarcoma misdiagnosed as a myxoma or malignant transformation of a cardiac myxoma? J Card Surg 2020; 36:357-362. [PMID: 33225534 DOI: 10.1111/jocs.15200] [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: 08/06/2020] [Revised: 10/08/2020] [Accepted: 11/04/2020] [Indexed: 12/01/2022]
Abstract
Cardiac intimal sarcoma is extremely rare and aggressive primary malignant cardiac tumors. Here, we reported the case of a young man initially operated for a tumor of the left atrium, causing a dynamic obstruction of the mitral valve and (mis-)diagnosed as a myxoma at the histopathological analysis. Patient presented a local recurrence at 3 months and was reoperated. Pathology revealed this time the presence of an intimal sarcoma. Patient received adjuvant chemotherapy. Despite a good local control, the 1-year follow-up positron emission tomography scan revealed the presence of a metastasis in the left adrenal gland that was surgically resected. This article aims to highlight the risk of misdiagnosis in case of cardiac tumors, the hypothetical concept of malignant transformation of a cardiac myxoma, the aggressive course of the extremely rare cardiac intimal sarcoma, and the therapeutic modalities available to treat this pathology.
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Affiliation(s)
- Rodolphe Durieux
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Vincent Tchana-Sato
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Jean-Paul Lavigne
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Marc A Radermecker
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Marie Moonen
- Department of Cardiology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Irène Scagnol
- Department of Pathology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Christine Gennigens
- Department of Medical Oncology, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Jean-Olivier Defraigne
- Department of Cardiothoracic Surgery, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
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13
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Mahmoud O, Haynos W, Rollor J. Left Atrial Thrombi Masquerading as Myxomas: Mini Case Series and Literature Review. CASE (PHILADELPHIA, PA.) 2020; 4:252-259. [PMID: 32875191 PMCID: PMC7451943 DOI: 10.1016/j.case.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Osama Mahmoud
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania
| | - William Haynos
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania
| | - Joyce Rollor
- Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania
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14
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L'Angiocola PD, Donati R. Cardiac Masses in Echocardiography: A Pragmatic Review. J Cardiovasc Echogr 2020; 30:5-14. [PMID: 32766100 PMCID: PMC7307625 DOI: 10.4103/jcecho.jcecho_2_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 01/07/2023] Open
Abstract
Transthoracic echocardiography is a useful diagnostic technique for the identification of intracardiac and extracardiac masses, which can evaluate morphologic properties of the masses such as their location, attachment, shape, size, mobility, and possible hemodynamic-related implications. Apart from physiological variants and structural normal mimickers, echocardiography can detect principal intracardiac masses such as neoplasms, thrombi, vegetation, and extracardiac masses such as metastatic lesions. Moreover, transesophageal echocardiography can provide further details and provide higher accuracy in case a deeper examination of the mass is needed. This review will focus on the systematic evaluation of intra-/extracardiac masses including epidemiology and morphological and echocardiographic features, providing practical and technical tips to health-care professionals to achieve correct identification of the masses. General data on cardiac masses were extracted via PubMed/MEDLINE search engine from indexed reviews, original studies, and clinical case reports. The echocardiographic features of cardiac masses were reviewed according to the most relevant international cardiology and echocardiography scientific societies' position statements.
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Affiliation(s)
| | - Roberto Donati
- Department of Cardiology, Giovan Battista Grassi Hospital, Rome, Italy
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15
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Casavecchia G, Lestuzzi C, Gravina M, Corrado G, Tusa M, Brunetti ND, Manuppelli V, Monte IP. Cardiac Tumors. J Cardiovasc Echogr 2020; 30:S45-S53. [PMID: 32566466 PMCID: PMC7293869 DOI: 10.4103/jcecho.jcecho_7_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/16/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiac tumors (CTs) are extremely rare, with an incidence of approximately 0.02% in autopsy series. Primary tumors of the heart are far less common than metastatic tumors. CTs usually present with any possible clinical combination of heart failure, arrhythmias, or embolism. Echocardiography remains the first diagnostic approach when suspecting a CT which, on the other side, frequently appears unexpectedly during an echocardiographic examination. Yet, cardiac tomography and especially magnetic resonance imaging may offer several adjunctive opportunities in the diagnosis of CTs. Early and exact diagnosis is crucial for the following therapy and outcome of CTs.
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Affiliation(s)
| | - Chiara Lestuzzi
- Department of Cardiology, Aviano Hospital, Pordenone, Aviano, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | - Maurizio Tusa
- Department of Cardiology, Milano San Donato Hospital, Milano, Italy
| | | | | | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania, Italy
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16
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Spies C, Metze M, Stöbe S, Hagendorff A. [Echocardiographic emergency diagnostics]. Herz 2019; 44:267-286. [PMID: 31020335 DOI: 10.1007/s00059-019-4799-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Echocardiography is a non-invasive, versatile imaging modality for the diagnostics and monitoring of life-threatening cardiac diseases. This article summarizes the currently valid recommendations on emergency echocardiography of the German Cardiac Society and the European Association of Cardiovascular Imaging and provides practical guidance for their implementation in emergency medicine. Echocardiography is especially important for the diagnostics of acute coronary syndrome and its potential complications, of pulmonary embolism and endocarditis as well as the differential diagnosis of patients in shock and in emergencies. A domain of increasing importance in echocardiography is the treatment monitoring of patients supported by modern cardiac assist devices.
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Affiliation(s)
- C Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - M Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
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17
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Szczerba E, Kowalik R, Gorska K, Mierzejewski M, Slowikowska A, Bednarczyk T, Marchel M, Krenke R, Opolski G. Severe mitral stenosis secondary to eosinophilic granulomatosis resolving after pharmacological treatment. Echocardiography 2018; 35:2099-2103. [PMID: 30338566 DOI: 10.1111/echo.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022] Open
Abstract
We present a case of 44-year-old woman who underwent effective pharmacological treatment of severe mitral stenosis. The patient was hospitalized due to rapidly progressive dyspnea. Her medical history included asthma, perennial rhinitis, and nasal polyps. Echocardiography showed a mass of the left ventricle involving the mitral valve; cardiac MRI suggested acute endocarditis. Severe peripheral blood eosinophilia was found. Eosinophilic granulomatosis with polyangiitis was diagnosed; treatment with prednisone and cyclophosphamide was started. Despite the clinical improvement, severe mitral stenosis persisted, surgical treatment was planned. However, evaluation after 6 cycles of cyclophosphamide pulse therapy revealed a significant regression of the valvular disease.
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Affiliation(s)
- Ewa Szczerba
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.,Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | - Robert Kowalik
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Gorska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Michal Mierzejewski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Anna Slowikowska
- Department of Cardiosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Bednarczyk
- Students' Scientific Group of First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michal Marchel
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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18
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Colin GC, Gerber BL, Amzulescu M, Bogaert J. Cardiac myxoma: a contemporary multimodality imaging review. Int J Cardiovasc Imaging 2018; 34:1789-1808. [DOI: 10.1007/s10554-018-1396-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022]
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19
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Eskandari M, Monaghan MJ. Contrast Echocardiography. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Barchitta A, Basso C, Piovesana PG, Antonini-Canterin F, Ruzza L, Bianchi A, Banzato A, Chiesa M, Thiene G, Gerosa G, Rizzo S. Opacification patterns of cardiac masses using low-mechanical index contrast echocardiography: comparison with histopathological findings. Cardiovasc Pathol 2017; 30:72-77. [PMID: 28793276 DOI: 10.1016/j.carpath.2017.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/25/2017] [Accepted: 06/26/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Two-dimensional echocardiography is the main noninvasive imaging tool to identify cardiac masses but is unable to provide detailed tissue characterization. AIM The aim of the study was to assess the ability of low mechanical index (MI) contrast echocardiography to detect presence and amount of tissue vascularization as validated by histopathology study of cardiac masses. METHODS AND RESULTS Twelve consecutive patients (5 females and 7 males, age range 51-82 years) underwent conventional and contrast two-dimensional echocardiography with low MI. By contrast echocardiography, mass enhancement was classified as absent (suggesting thrombus), partial, or complete (suggesting vascularized mass, both with early or late >20 cycles of opacification) as compared to the adjacent myocardium. The precise nature of the cardiac masses was provided by histopathology examination and/or by resolution after anticoagulation therapy during follow-up. Presence, type, and degree of mass vascularization were assessed by histology, immunohistochemistry, and morphometric analysis. Among the 12 cases, mass enhancement was absent, late and peripheral, late and partial, and early and complete in three cases each. Cardiac masses consisted of thrombus (three), secondary malignant cardiac tumor (three), myxoma (three), papillary fibroelastoma (two), and cavernous hemangioma (one). At histology, cardiac hemangioma had the highest degree of vascularization, at difference from thrombi which were not vascularized, and data were in keeping with contrast echocardiography findings. CONCLUSIONS Low MI contrast echocardiography is an easy, noninvasive cardiac imaging tool to assess cardiac mass vascularization. The degree of contrast enhancement and time to opacification are highly variable among cardiac masses and correspond to different extent of vascularization.
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Affiliation(s)
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy.
| | | | | | | | | | | | | | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
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21
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Mankad R, Herrmann J. Cardiac tumors: echo assessment. Echo Res Pract 2016; 3:R65-R77. [PMID: 27600455 PMCID: PMC5292983 DOI: 10.1530/erp-16-0035] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 12/20/2022] Open
Abstract
Cardiac tumors are exceedingly rare (0.001–0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.
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Affiliation(s)
- Rekha Mankad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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22
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Rinuncini M, Zuin M, Scaranello F, Fejzo M, Rampin L, Rubello D, Faggian G, Roncon L. Differentiation of cardiac thrombus from cardiac tumor combining cardiac MRI and 18F-FDG-PET/CT Imaging. Int J Cardiol 2016; 212:94-6. [PMID: 27038712 DOI: 10.1016/j.ijcard.2016.03.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
Abstract
Radiological differentiation of an unknown cardiac masse is often a challenging issue. 18F-FDG-PET/CT imaging was performed to evaluate a left ventricle mass visualized on transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) in a patient with an history of ischemic heart disease. The metabolically inert area on the PET/CT, corresponding to the relatively homogenous hypodensity in the LV, was thought to represent an old organized LV thrombus. Histopathological examination confirmed the imaging diagnosis.
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Affiliation(s)
- Massimo Rinuncini
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Marco Zuin
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Majlinda Fejzo
- Department of Radiology, Santa Maria della Misericordia Hospital
| | - Lucia Rampin
- Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Domenico Rubello
- Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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23
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Duke J, Greaves K, Dettrick A. Use of microbubble contrast in the diagnosis of a left ventricular papillary fibroelastoma. Echo Res Pract 2015; 2:K43-5. [PMID: 26796764 PMCID: PMC4683421 DOI: 10.1530/erp-15-0033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/24/2022] Open
Abstract
A papillary fibroelastoma is a rare, avascular, cardiac tumour that is often found incidentally using transthoracic echocardiography (TTE). Peripheral i.v. injection of a microbubble contrast agent is often used to characterize abnormal masses within the heart allowing further delineation of physical features, the area of attachment, and vascularity of the mass in order to differentiate the growth from a tumour or a thrombus. This case highlights a potential pitfall when assessing a cardiac tumour's vascularity using contrast TTE. A cardiac mass was identified on a TTE of a 53-year-old man and was further investigated with microbubble contrast-enhanced TTE. Contrast TTE imaging suggested a vascularized structure in the left ventricle. However, after histological examination the tumour was found to be entirely avascular.
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Affiliation(s)
- Jenny Duke
- Department of Medicine, University of Queensland , Brisbane, Queensland , Australia
| | - Kim Greaves
- Department of Cardiology, Sunshine Coast Hospital and Health Services , Nambour, Queensland , Australia
| | - Andrew Dettrick
- Department of Pathology, Sunshine Coast Hospital and Health Services , Nambour, Queensland , Australia
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24
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Tang QY, Guo LD, Wang WX, Zhou W, Liu YN, Liu HY, Li L, Deng YB. Usefulness of contrast perfusion echocardiography for differential diagnosis of cardiac masses. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2382-2390. [PMID: 26087885 DOI: 10.1016/j.ultrasmedbio.2015.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/08/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to assess the usefulness of contrast perfusion echocardiography in the differential diagnosis of different types of cardiac masses. Conventional echocardiography and contrast perfusion echocardiography were performed in 72 patients with cardiac masses. The degree of contrast enhancement of the mass and an adjacent section of myocardium after injection of contrast agent was determined by visual inspection and quantitative time-signal intensity curve analysis. The difference in maximal steady-state pixel intensity between the mass and the adjacent myocardium (ΔAmass-myocardium) was calculated. All masses had a pathologic diagnosis or resolved after anticoagulation. All 16 cardiac masses without enhancement on visual inspection were confirmed to be cardiac thrombi. Twenty-four masses with incomplete enhancement on visual inspection were recognized as benign tumors with validation methods. Of the 32 cardiac masses with complete enhancement, 30 were confirmed as malignant tumors and two as benign tumors with validation methods. The sensitivity and specificity of ΔAmass-myocardium in differentiating thrombi from tumors were 93% and 100%, respectively, and 100% and 97% in differentiating malignant tumors from benign tumors and thrombi. Both visual and quantitative assessment of degree of enhancement of cardiac masses in relation to the adjacent myocardium during contrast perfusion echocardiography had high diagnostic accuracy for differentiation of a thrombus from a tumor or a benign tumor from a malignant tumor.
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Affiliation(s)
- Qiao-Ying Tang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling-Dan Guo
- Department of Medical Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Xuan Wang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya-Ni Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Yun Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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25
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Ederhy S, Soulat-Dufour L, Ileana E, Mir O, Haddour N, Boccara F, Soria JC, Cohen A. Apport de l’imagerie dans l’évaluation des masses et métastases cardiaques. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2394-y] [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]
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26
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27
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Vanichakarn P, Beaver TA, Costa SP, Czum JM, Palac RT. An unusual left atrial mass in hypertrophic cardiomyopathy: the role of multimodality imaging. Echocardiography 2013; 30:E111-3. [PMID: 23305199 DOI: 10.1111/echo.12097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Pantila Vanichakarn
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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28
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Lanza GA, Camici PG, Galiuto L, Niccoli G, Pizzi C, Di Monaco A, Sestito A, Novo S, Piscione F, Tritto I, Ambrosio G, Bugiardini R, Crea F, Marzilli M. Methods to investigate coronary microvascular function in clinical practice. J Cardiovasc Med (Hagerstown) 2013; 14:1-18. [DOI: 10.2459/jcm.0b013e328351680f] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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29
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Lip GYH, Ponikowski P, Andreotti F, Anker SD, Filippatos G, Homma S, Morais J, Pullicino P, Rasmussen LH, Marin F, Lane DA. Thrombo-embolism and antithrombotic therapy for heart failure in sinus rhythm. A joint consensus document from the ESC Heart Failure Association and the ESC Working Group on Thrombosis. Eur J Heart Fail 2012; 14:681-95. [PMID: 22611046 DOI: 10.1093/eurjhf/hfs073] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chronic heart failure (HF) with either reduced or preserved ejection fraction is common and remains an extremely serious disorder with a high mortality and morbidity. Many complications related to HF can be related to thrombosis. Epidemiological and pathophysiological data also link HF to an increased risk of thrombosis, leading to the clinical consequences of sudden death, stroke, systemic thrombo-embolism, and/or venous thrombo-embolism. This consensus document of the Heart Failure Association (EHFA) of the European Society of Cardiology (ESC) and the ESC Working Group on Thrombosis reviews the published evidence and summarizes 'best practice', and puts forward consensus statements that may help to define evidence gaps and assist management decisions in everyday clinical practice. In HF patients with atrial fibrillation, oral anticoagulation is recommended, and the CHA(2)DS(2)-VASc and HAS-BLED scores should be used to determine the likely risk-benefit ratio (thrombo-embolism prevention vs. risk of bleeding) of oral anticoagulation. In HF patients with reduced left ventricular ejection fraction who are in sinus rhythm there is no evidence of an overall benefit of vitamin K antagonists (e.g. warfarin) on mortality, with risk of major bleeding. Despite the potential for a reduction in ischaemic stroke, there is currently no compelling reason to use warfarin routinely for these patients. Risk factors associated with increased risk of thrombo-embolic events should be identified and decisions regarding use of anticoagulation individualized. Patient values and preferences are important determinants when balancing the risk of thrombo-embolism against bleeding risk. New oral anticoagulants that offer a different risk-benefit profile compared with warfarin may appear as an attractive therapeutic option, but this would need to be confirmed in clinical trials.
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Affiliation(s)
- Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK.
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30
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Tolstrup K, Shiota T, Gurudevan S, Luthringer D, Luo H, Siegel RJ. Left Atrial Myxomas: Correlation of Two-Dimensional and Live Three-Dimensional Transesophageal Echocardiography with the Clinical and Pathologic Findings. J Am Soc Echocardiogr 2011; 24:618-24. [DOI: 10.1016/j.echo.2011.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Indexed: 12/15/2022]
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31
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Jiménez-Juan L, Leen J, Wald RM, Nguyen ET, Yan AT, Kirpalani A, Wintersperger BJ, Crean AM. Multimodality imaging in the evaluation of cardiovascular manifestations of malignancy. Cardiol Res Pract 2011; 2011:378041. [PMID: 21490697 PMCID: PMC3066556 DOI: 10.4061/2011/378041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/03/2011] [Indexed: 11/20/2022] Open
Abstract
Up to one third of the population will die as a direct result of cancer. Accurate and timely diagnosis of disease often requires multiple different approaches including the use of modern imaging techniques. Prompt recognition of adverse consequences of some anti-cancer therapies also requires a knowledge of the optimum imaging strategy for the problem at hand. The purpose of this article is to review not only some of the commoner cardiovascular manifestations of malignancy but also to discuss the strengths, weaknesses and appropriate use of cardiovascular imaging modalities.
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Affiliation(s)
- Laura Jiménez-Juan
- Department of Medical Imaging, University Health Network, Toronto, ON, Canada M5G 2C4
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Clarke R, Wells J, Finn C. Morphology Identification Using Transesophageal Echocardiography in Migratory Renal Cell Carcinoma Surgery. J Cardiothorac Vasc Anesth 2011; 25:153-5. [DOI: 10.1053/j.jvca.2010.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Indexed: 11/11/2022]
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Diagnostic value of contrast echocardiography in Tako-Tsubo cardiomyopathy. Arch Cardiovasc Dis 2010; 103:447-53. [PMID: 21074123 DOI: 10.1016/j.acvd.2010.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/12/2010] [Accepted: 08/21/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tako-Tsubo cardiomyopathy is a clinical entity mimicking acute coronary syndrome. Assessment of left ventricular function may be difficult using conventional echocardiography. AIMS to characterize left ventricular systolic function using contrast echocardiography in Tako-Tsubo cardiomyopathy. METHODS We prospectively studied 63 consecutive women admitted for suspected acute coronary syndrome who underwent coronary arteriography, biplane left ventricular angiography and conventional and contrast echocardiography; 25 women had Tako-Tsubo cardiomyopathy (group 1), 25 women had proven coronary artery disease (group 2) and 13 women had no significant coronary lesion (group 3). Echocardiographic interpretation was performed by two observers: a physician trainee (observer 1) and an experienced investigator (observer 2). RESULTS Left ventricular segments were assessed for wall motion abnormalities, which were present in 70 and 88% (observer 1) and in 91 and 99% (observer 2), using conventional and contrast echocardiography, respectively (P<0.0001). Accuracy for the diagnosis of Tako-Tsubo cardiomyopathy was improved significantly for both observers using contrast echocardiography: for observer 1, sensitivity was 56 and 88%, respectively, using conventional and contrast echocardiography (P=0.01), whereas for observer 2, sensitivity was 72 and 96%, respectively (P=0.04). Interobserver agreement was excellent using contrast agent (kappa=0.85 vs 0.34 using conventional echocardiography). The blinded review of left ventriculograms distinguished Tako-Tsubo cardiomyopathy from coronary artery disease correctly in 96% of cases. CONCLUSIONS Contrast echocardiography could be used in routine practice to replace left ventricular angiography in Tako-Tsubo cardiomyopathy.
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Hari P, Mohamad T, Kondur A, Jahania SM, Afonso L. Incremental value of contrast echocardiography in the diagnosis of atrial myxoma. Echocardiography 2010; 27:E46-9. [PMID: 20374266 DOI: 10.1111/j.1540-8175.2009.01128.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intracardiac myxomas have traditionally been divided into solid ovoid and soft papillary types based on a morphological appearance. Papillary myxomas given their friable nature are far more likely to cause embolic phenomenon and present with neurological symptoms, making it necessary to discriminate between these tumor subtypes. Papillary myxomas have also been demonstrated to be significantly less vascular than their ovoid counterparts in previous angiographic studies. We describe here for the first time, the application of transesophageal real time myocardial contrast echocardiography in a case of atrial papillary myxoma to assess tumor vascularity. (Echocardiography 2010;27:E46-E49).
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Affiliation(s)
- Pawan Hari
- Division of Internal Medicine, Wayne State University, Detroit, MI 48201, USA
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Diebold B. Contrast echocardiography, tumors and thrombus: a new episode in a 50-year history. Arch Cardiovasc Dis 2009; 102:163-4. [PMID: 19375668 DOI: 10.1016/j.acvd.2009.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 02/20/2009] [Indexed: 12/18/2022]
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