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Seo KW, Hong YS, Park JS. Rare Cause of Exertional Angina. J Korean Med Sci 2023; 38:e421. [PMID: 38147842 PMCID: PMC10752745 DOI: 10.3346/jkms.2023.38.e421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/24/2023] [Indexed: 12/28/2023] Open
Affiliation(s)
- Kyoung-Woo Seo
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - You Sun Hong
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
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2
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Riad M, Rahman MU, Mulyala R, Sayyed N, Bayer D, Omar B. Percutaneous Intracardiac Mass Extraction in High Surgical-Risk Patients. J Med Cases 2023; 14:362-368. [PMID: 38029057 PMCID: PMC10681765 DOI: 10.14740/jmc4150] [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: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Large intracardiac masses including tumors, thrombi, and vegetations result in detrimental embolic or obstructive sequelae and present a management dilemma. Open heart surgery, the traditional approach, may not be an option for many patients with a prohibitive surgical risk due to multiple comorbidities. Recently, percutaneous options have emerged with reported success in extracting such intracardiac masses. A 42-year-old female with history of advanced primary sclerosing cholangitis with decompensated liver cirrhosis causing ascites and variceal bleed presented to the emergency department with fatigue, subjective fevers, chills and melena. Laboratory results revealed neutrophil-predominant leukocytosis and normocytic anemia, and blood cultures were positive for Candida albicans. Electrocardiography showed sinus tachycardia. Chest X-ray was unremarkable. She underwent packed red blood cell transfusion and esophageal banding for variceal bleeding. Transthoracic echocardiogram revealed normal left ventricular ejection fraction and no wall motion abnormalities. A right atrial mobile mass measuring approximately 1.0 × 3.0 cm was noted. Multidisciplinary heart team discussion concluded that while the mass posed a high embolic risk, the patient had a prohibitive risk for surgical intervention. Successful percutaneous removal of the mass using Penumbra system device (Penumbra Incorporated, Alameda, CA) was accomplished. This case report details the procedure and outcomes, as well as presents a literature review.
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Affiliation(s)
- Mariam Riad
- Cardiology Division, University of South Alabama, Mobile, AL 36617, USA
| | | | | | - Nadia Sayyed
- Department of Internal Medicine, Khyber Medical College, Peshawar, Pakistan
| | - Danielle Bayer
- Cardiology Division, University of South Alabama, Mobile, AL 36617, USA
| | - Bassam Omar
- Cardiology Division, University of South Alabama, Mobile, AL 36617, USA
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3
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Alerhand S, Adrian RJ. What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension? Am J Emerg Med 2023; 72:72-84. [PMID: 37499553 DOI: 10.1016/j.ajem.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) and pulmonary hypertension (PH) are potentially fatal disease states. Early diagnosis and goal-directed management improve outcomes and survival. Both conditions share several echocardiographic findings of right ventricular dysfunction. This can inadvertently lead to incorrect diagnosis, inappropriate and potentially harmful management, and delay in time-sensitive therapies. Fortunately, bedside echocardiography imparts a few critical distinctions. OBJECTIVE This narrative review describes eight physiologically interdependent echocardiographic parameters that help distinguish acute PE and chronic PH. The manuscript details each finding along with associated pathophysiology and summarization of the literature evaluating diagnostic utility. This guide then provides pearls and pitfalls with high-quality media for the bedside evaluation. DISCUSSION The echocardiographic parameters suggesting acute or chronic right ventricular dysfunction (best used in combination) are: 1. Right heart thrombus (acute PE) 2. Right ventricular free wall thickness (acute ≤ 5 mm, chronic > 5 mm) 3. Tricuspid regurgitation pressure gradient (acute ≤ 46 mmHg, chronic > 46 mmHg, corresponding to tricuspid regurgitation maximal velocity ≤ 3.4 m/sec and > 3.4 m/sec, respectively) 4. Pulmonary artery acceleration time (acute ≤ 60-80 msec, chronic < 105 msec) 5. 60/60 sign (acute) 6. Pulmonary artery early-systolic notching (proximally-located, higher-risk PE) 7. McConnell's sign (acute) 8. Right atrial enlargement (equal to left atrial size suggests acute, greater than left atrial size suggests chronic). CONCLUSIONS Emergency physicians must appreciate the echocardiographic findings and associated pathophysiology that help distinguish acute and chronic right ventricular dysfunction. In the proper clinical context, these findings can point towards PE or PH, thereby leading to earlier goal-directed management.
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Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Robert James Adrian
- Department of Emergency Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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4
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Sanchez-Nadales A, Khanna-Neicheril R, Asher CR, Lopez D. Challenges in diagnosis and therapeutic options for metastatic prostate cancer to the right ventricle. BMJ Case Rep 2023; 16:e254387. [PMID: 37353239 PMCID: PMC10314604 DOI: 10.1136/bcr-2022-254387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
Our patient presented with right-sided heart failure symptoms and found to have a large mass protruding into the heart's right ventricle. Cardiac MRI delineated the morphological and tissue characteristics of the tumour. Although 18-fluorodeoxyglucose positron emission tomography (PET) did not reveal an intracardiac mass, the lesion was well demonstrated by Fluciclovine F18 PET/CT.
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Affiliation(s)
| | | | - Craig R Asher
- Heart and Vascular Institute, Cleveland Clinic Florida, Weston, Florida, USA
| | - David Lopez
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, Florida, USA
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5
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Moskal P, Kubicz E, Grudzień G, Czerwiński E, Dulski K, Leszczyński B, Niedźwiecki S, Stępień EŁ. Developing a novel positronium biomarker for cardiac myxoma imaging. EJNMMI Phys 2023; 10:22. [PMID: 36959477 PMCID: PMC10036702 DOI: 10.1186/s40658-023-00543-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE Cardiac myxoma (CM), the most common cardiac tumor in adults, accounts for 50-75% of benign cardiac tumors. The diagnosis of CM is often elusive, especially in young stroke survivors and transthoracic echocardiography (TTE) is the initial technique for the differential diagnostics of CM. Less invasive cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are not available for the majority of cardiac patients. Here, a robust imaging approach, ortho-Positronium (o-Ps) imaging, is presented to determine cardiac myxoma extracted from patients undergoing urgent cardiac surgery due to unexpected atrial masses. We aimed to assess if the o-Ps atom, produced copiously in intramolecular voids during the PET imaging, serves as a biomarker for CM diagnosing. METHODS Six perioperative CM and normal (adipose) tissue samples from patients, with primary diagnosis confirmed by the histopathology examination, were examined using positron annihilation lifetime spectroscopy (PALS) and micro-CT. Additionally, cell cultures and confocal microscopy techniques were used to picture cell morphology and origin. RESULTS We observed significant shortening in the mean o-Ps lifetime in tumor with compare to normal tissues: an average value of 1.92(02) ns and 2.72(05) ns for CM and the adipose tissue, respectively. Microscopic differences between tumor samples, confirmed in histopathology examination and micro-CT, did not influenced the major positronium imaging results. CONCLUSIONS Our findings, combined with o-Ps lifetime analysis, revealed the novel emerging positronium imaging marker (o-PS) for cardiovascular imaging. This method opens the new perspective to facilitate the quantitative in vivo assessment of intracardiac masses on a molecular (nanoscale) level.
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Affiliation(s)
- Paweł Moskal
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland.
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland.
- Center for Theranostics, Jagiellonian University, Kraków, Poland.
| | - Ewelina Kubicz
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland.
- Center for Theranostics, Jagiellonian University, Kraków, Poland.
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland.
| | - Grzegorz Grudzień
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Eryk Czerwiński
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland
| | - Kamil Dulski
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland
| | - Bartosz Leszczyński
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
| | - Szymon Niedźwiecki
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland
| | - Ewa Ł Stępień
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland.
- Center for Theranostics, Jagiellonian University, Kraków, Poland.
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland.
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Sykora D, Chaliki HP, Cummings KW, Sell-Dottin K, Stanton ML, Scott LR. Incidentally Discovered Right Atrial Mass: A Rare and Unexpected Etiology. Tex Heart Inst J 2023; 50:492268. [PMID: 37060553 PMCID: PMC10178659 DOI: 10.14503/thij-21-7735] [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: 04/16/2023]
Abstract
Primary cardiac sarcoma is a rare type of intracardiac mass. This report describes a patient with atrial flutter who had a new right atrial mass incidentally discovered on transesophageal echocardiography. A thrombus was suspected based on radiographic appearance, but there was minimal change with anticoagulation. The mass was resected and found to be an undifferentiated pleomorphic cardiac sarcoma, an uncommon sub-type within the already rare category of primary cardiac neoplasms. This report highlights the importance of considering primary malignancy and thoroughly correlating radiographic and clinical evidence during the diagnostic workup of patients with intracardiac masses.
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Affiliation(s)
- Daniel Sykora
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Hari P Chaliki
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Kristen Sell-Dottin
- Department of Cardiovascular Surgery, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Luis R Scott
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
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7
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Paolisso P, Foà A, Bergamaschi L, Graziosi M, Rinaldi A, Magnani I, Angeli F, Stefanizzi A, Armillotta M, Sansonetti A, Fabrizio M, Amicone S, Impellizzeri A, Tattilo FP, Suma N, Bodega F, Canton L, Gherbesi E, Tuttolomondo D, Caldarera I, Maietti E, Carugo S, Gaibazzi N, Rucci P, Biagini E, Galiè N, Pizzi C. Echocardiographic Markers in the Diagnosis of Cardiac Masses. J Am Soc Echocardiogr 2023; 36:464-473.e2. [PMID: 36610495 DOI: 10.1016/j.echo.2022.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The echocardiographic parameters required for a comprehensive assessment of cardiac masses (CMs) are still largely unknown. The aim of this study was to identify and integrate the echocardiographic features of CMs that can accurately predict malignancy. METHODS An observational cohort study was conducted among 286 consecutive patients who underwent standard echocardiographic assessment for suspected CM at Bologna University Hospital between 2004 and 2022. A definitive diagnosis was achieved by histologic examination or, in the case of cardiac thrombi, with radiologic evidence of thrombus resolution after appropriate anticoagulant treatment. Logistic and multivariable regression analysis was performed to confirm the ability of six echocardiographic parameters to discriminate malignant from benign masses. The unweighted count of these parameters was used as a numeric score, ranging from 0 to 6, with a cutoff of ≥3 balancing sensitivity and specificity with respect to the histologic diagnosis of malignancy. Classification tree analysis was used to determine the ability of echocardiographic parameters to discriminate subgroups of patients with differential risk for malignancy. RESULTS Benign masses were more frequently pedunculated, mobile, and adherent to the interatrial septum (P < .001). Malignant masses showed a greater diameter and exhibited a higher frequency of irregular margins, an inhomogeneous appearance, sessile implantation, polylobate shape, and pericardial effusion (P < .001). Infiltration, moderate to severe pericardial effusion, nonleft localization, sessile implantation, polylobate shape, and inhomogeneity were confirmed to be independent predictors of malignancy in both univariate and multivariable models. The predictive ability of the unweighted score of ≥3 was very high (>0.90) and similar to that of the previously published weighted score. Classification tree analysis generated an algorithm in which infiltration was the best discriminator of malignancy, followed by nonleft localization and sessile implantation. The percentage correctly classified by classification tree analysis as malignant was 87.5%. Agreement between observer readings and CM histology ranged between 85.1% and 91.5%. The presence of at least three echocardiographic parameters was associated with lower survival. CONCLUSIONS In the approach to CMs, some echocardiographic parameters can serve as markers to accurately predict malignancy, thereby informing the need for second-level investigations and minimizing the diagnostic delay in such a complex clinical scenario.
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Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Alberto Foà
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Luca Bergamaschi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Maddalena Graziosi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Andrea Rinaldi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Ilenia Magnani
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Francesco Angeli
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Andrea Stefanizzi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Matteo Armillotta
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Angelo Sansonetti
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Michele Fabrizio
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Sara Amicone
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Andrea Impellizzeri
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Francesco Pio Tattilo
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Nicole Suma
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Francesca Bodega
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Lisa Canton
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Elisa Gherbesi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | | | - Ilaria Caldarera
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Elisa Maietti
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | | | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elena Biagini
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Nazzareno Galiè
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Carmine Pizzi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy.
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Montoya-Beltran JS, Herrera LR, Marín PO, Navajas AN, Manrique Espinel FT. Atrial Fusocellular Sarcoma: An Uncommon Presentation. CASE 2023; 7:105-108. [PMID: 37065836 PMCID: PMC10103005 DOI: 10.1016/j.case.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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9
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Gomase S, Kuthe S, Sonkusale M. Case Report-Right atrial myxoma with total anomalous pulmonary venous connection in neonate. Int J Surg Case Rep 2022; 97:107438. [PMID: 35908453 PMCID: PMC9403170 DOI: 10.1016/j.ijscr.2022.107438] [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: 05/20/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Myxoma is the commonest cardiac tumor in adults but is very rare in a newborn. The majority of myxoma arises from the interatrial septum. 75% of myxomas are found in the left atrium and 20% are found in the right atrium. Myxomas can be single or multiple. Multiple myxomas are usually associated with familial syndromes. Myxomas are generally not associated with another congenital heart defect except atrial septal defect. As myxomas are rare in newborns most of the knowledge is through various case reports. CASE PRESENTATION We report a rare case of an 8-day-old neonate presenting with cyanosis and respiratory distress. Transthoracic echocardiography was suggestive of right atrial myxoma which was arising from the atrioventricular junction on the right side of an interatrial septum. It was associated with the total anomalous pulmonary venous connection. The patient underwent successful excision of myxoma and rerouting of the common venous chamber to the left atrium with an uneventful immediate postoperative course. CLINICAL DISCUSSION Cardiac myxomas are rare in newborns and their association with TAPVC even rare. Our patient had single atrial myxoma with TAPVC. The significance of this association is not clear. This association is mostly by chance. Probably it is the first case reported of its kind. CONCLUSION As myxomas are very rare in neonates, it is highly possible to miss other associated structural heart defects. Diagnosis of atrial myxoma can be suggested by echocardiogram but a definite diagnosis can only be confirmed by histology.
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Affiliation(s)
- Shantanu Gomase
- Dept of Pediatrics, Jawaharlal Nehru Medical College, DMIMS, Sawangi (M), India.
| | - Sachin Kuthe
- Department of Cardiovascular and Thoracic Surgery, Jawaharlal Nehru Medical College, DMIMS, Sawangi (M), India
| | - Manish Sonkusale
- Department of Anesthesia, Jawaharlal Nehru Medical College, DMIMS, Sawangi (M), India
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10
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Gripari P, Pepi M, Fusini L, Tamborini G, Mancini ME, Andreini D, Pontone G, Saccocci M, Giambuzzi I, Alamanni F, Zanobini M. Cardiac tumors: imaging findings, clinical correlations and surgical treatment in a 15 years single-center experience. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:212-221. [PMID: 34825795 DOI: 10.23736/s0021-9509.21.12052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The aims of this study were: to present the clinical and pathological characteristics of cardiac tumors in a single-center series of patients; to describe the association of imaging characteristics, clinical presentation and surgical treatment; to analyze if second level imaging tests, computed tomography (CT) and cardiac magnetic resonance (CMR); and to improve the diagnostic accuracy when compared to first-line imaging technique (transthoracic echocardiography [TTE]). METHODS We reviewed the medical and surgical records, TTE, CT and CMR examinations of 86 patients with a histological diagnosis of cardiac tumors between 2004 and 2019. RESULTS The majority were benign tumors (81%) with myxoma accounting for 66% of cases. Among malignancies, metastasis (8%) and primary tumors (10%) were equally recognized. Symptoms at presentation (45% of patients) were associated to larger diameters at TTE. Malignancies were larger (mean diameter 37±14 mm vs. 27±13 mm, P<0.01), more frequently exhibited irregular shape (67% vs. 17%, P<0.01), frayed or polylobulated surface (73% vs. 38%, P=0.035), heterogeneous aspect (67% vs. 32%, P=0.012). A maximum diameter >28 mm and a minimum diameter >19.5 mm emerged as possible cut-off values for the differentiation of benign and malignant tumors. The ability of TTE, CT and CMR features in identifying malignancies was moderate (diagnostic accuracy of 84%, 81%, 76% respectively). The mean survival time after surgery was 1.6±1.4 years in malignancies and 6.8±4.7 years in benign tumors. CONCLUSIONS Cardiac tumors are rare and mostly benign; their nature and clinics related to TTE appearance. CT and CMR may be used synergically with TTE. Surgery is curative in benign tumors, survival remains scarce in malignancies.
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Affiliation(s)
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | | | | | - Matteo Saccocci
- Division of Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
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11
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Ahn J, Burke C, Howitt L, Glenie T, Lau G. A case of massive left atrial thrombus. Echocardiography 2021; 39:104-108. [PMID: 34866249 DOI: 10.1111/echo.15217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- John Ahn
- Cardiology Department, North Shore Hospital, Auckland, New Zealand
| | - Colin Burke
- Cardiology Department, North Shore Hospital, Auckland, New Zealand
| | - Lindsay Howitt
- Cardiology Department, North Shore Hospital, Auckland, New Zealand
| | - Tim Glenie
- Cardiology Department, North Shore Hospital, Auckland, New Zealand
| | - Gary Lau
- Cardiology Department, North Shore Hospital, Auckland, New Zealand
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12
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Sun T, Lu GL, Ma LC, Huang JZ, Xie SB. Multimodal echocardiography in the diagnosis of masses localized to the proximal portions of pulmonary arteries. Int J Cardiovasc Imaging 2021; 38:149-158. [PMID: 34716510 DOI: 10.1007/s10554-021-02427-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
Proximal pulmonary artery masses are exceedingly rare, and their diagnosis and therapy are important and challenging for clinicians. This study reviews our experience exploring the value of a combination of transthoracic echocardiography and contrast echocardiography for the differential diagnosis of proximal pulmonary artery masses. Between January 2018 and June 2021, 44 patients diagnosed with a mass attached to the major pulmonary artery and straddling the bilateral pulmonary arteries or pulmonary valve on transthoracic echocardiography were referred to this study. Contrast echocardiography was performed in 17 patients. Masses were diagnosed based on their site of attachment, shape, size, mobility, hemodynamic consequences on transthoracic echocardiography, and tissue perfusion on contrast echocardiographic perfusion imaging. Pathological data were collected from medical records and analyzed. The most frequent location of proximal pulmonary artery masses was the major pulmonary artery trunk. Twelve patients underwent complete mass resection, whereas nine patients underwent percutaneous pulmonary artery biopsy puncture and had a pathological diagnosis. Another 24 patients were confirmed with the validation methods. Contrast echocardiography has good sensitivity and specificity for differentiating thrombi from pulmonary artery sarcomas (PAS). The mass types were distributed as follows: thrombi (19, 43%), PAS (15, 34%), metastatic tumors (6, 14%), vegetations (3, 7%), and primary benign lesions (1, 2%). The majority of proximal pulmonary artery masses were thrombi or PAS. A combination of transthoracic echocardiography and contrast echocardiography offers advantages in the early identification of proximal pulmonary masses and provides clinically important information about the characteristics of masses, especially for differentiating thrombi from PAS.
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Affiliation(s)
- Ting Sun
- Department of Ultrasonography, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guo-Liang Lu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151 Yanjiang West Road, Guangzhou, 510120, China
| | - Lun-Chao Ma
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151 Yanjiang West Road, Guangzhou, 510120, China
| | - Jie-Zhou Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151 Yanjiang West Road, Guangzhou, 510120, China
| | - Shao-Bo Xie
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151 Yanjiang West Road, Guangzhou, 510120, China.
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13
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Lee SH, Choi JH. Right Atrial Blood Cyst Mimicking a Vegetative Mass. KOSIN MEDICAL JOURNAL 2021. [DOI: 10.7180/kmj.2021.36.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
<p>A 79-year-old woman presented to another hospital with complaints of right leg pain. Computed tomography and magnetic resonance imaging of the spine was performed in the other hospital, which showed an abscess in the right iliacus muscle. She was referred to our hospital because of a mass in the right atrium on echocardiography. Inflammatory markers were elevated, and Staphylococcus aureus were identified in blood cultures. Transthoracic echocardiography revealed a shaggy mass in the right atrium that resembled vegetation. Transesophageal echocardiography showed a large cystic mass with a hyperechoic lesion. After surgery, biopsy results indicated that it was a myxoid mass with cystic changes.
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14
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Mir H, McClure A, Thampinathan B, Chow C, Cusimano RJ, Bogoch II, Thavendiranathan P. Echocardiographic Features of Cardiac Echinococcal Infection. CASE (PHILADELPHIA, PA.) 2021; 5:26-32. [PMID: 33644510 PMCID: PMC7887517 DOI: 10.1016/j.case.2020.10.002] [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] [Indexed: 11/22/2022]
Abstract
Cardiac masses are a rare but important finding requiring detailed investigation. Echocardiography is a first-line imaging modality. CT and MRI together allow precise structural and tissue characterization. Surgical removal is a potentially curative treatment for cardiac hydatid cysts.
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Affiliation(s)
- Hassan Mir
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew McClure
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Babitha Thampinathan
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Cindy Chow
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Cusimano
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Isaac I Bogoch
- Divisions of Infectious Diseases and General Internal Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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15
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Garcia-Nicoletti M, Sinha MD, Savis A, Adalat S, Karunanithy N, Calder F. Silent and dangerous: catheter-associated right atrial thrombus (CRAT) in children on chronic haemodialysis. Pediatr Nephrol 2021; 36:1245-1254. [PMID: 33125532 PMCID: PMC8009777 DOI: 10.1007/s00467-020-04743-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/05/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Catheter-associated right atrial thrombus (CRAT) is a recognised complication of central venous catheter (CVC) use for haemodialysis (HD) patients. METHODS This was a single-centre retrospective longitudinal observational study of consecutive children aged 6 months-18 years over a 7-year period receiving in-centre chronic HD. Echocardiograms as per routine cardiac surveillance were performed 6 months or earlier given clinical concerns. RESULTS Sixty-five children, 36 boys (55.4%), median (IQR) age 11.8 (5.3, 14.7) years, received HD for kidney failure with replacement therapy (KFRT). Initial modality was HD in 45 (69.2%), with CVC as initial access in 42 (93.3%) and AVF in 3 (6.7%); in the remaining 20 (30.8%) patients PD was the initial modality before switching to HD. Seven of 65 (10.8%) developed CRAT at median 2 (0.8, 8.4) months from CVC insertion, with one CRAT detected 3 days following insertion. One child had 2 episodes of CRAT and one additionally thrombosed their AVF. No patient had an underlying primary kidney disease associated with a pro-thrombotic state. Those with CRAT were younger, had more frequent CVC change and received dialysis for longer duration compared to those with no CRAT. Six episodes of CRAT (75%) received anticoagulation therapy. Infective complications were observed in 25% and catheter malfunction in 50%. Five CRAT episodes (62.5%) resulted in CVC loss. One patient died after a haemorrhagic complication of anticoagulation and sepsis, and another developed life-threatening superior vena cava obstruction syndrome. Overall mortality 14% (1/7). CONCLUSIONS This is the first report of CRAT in a paediatric HD population. There was ~ 11% incidence of CRAT in patients receiving chronic HD detected by surveillance echocardiography. Although frequently asymptomatic, CRAT is associated with serious sequelae. Anticoagulation and surveillance with expert echocardiography remain mainstays of management. Graphical abstract.
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Affiliation(s)
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, London, SE1 7EH UK ,Kings College London, London, UK
| | - Alexandra Savis
- Department of Paediatric Cardiology, Evelina London Children’s Hospital, London, UK
| | - Shazia Adalat
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, London, SE1 7EH UK
| | - Narayan Karunanithy
- Department of Intervention Radiology, Evelina London Children’s Hospital, London, UK ,School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Francis Calder
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London, SE1 7EH, UK. .,Department of Paediatric Transplantation, Evelina London Children's Hospital, London, UK.
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16
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Sonaglioni A, Nicolosi GL, Lombardo M, Anzà C, Ambrosio G. Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging. Angiology 2020; 72:355-363. [PMID: 33231099 DOI: 10.1177/0003319720974882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pulsed wave tissue Doppler imaging (PW-TDI) easily detects motion of cardiac structures. Hence, PW-TDI could be of value for assessing potentially cardioembolic masses. We sought to evaluate the prognostic value of left ventricular (LV) thrombus mobility assessed by PW-TDI. In 83 consecutive patients with echocardiographically detected LV thrombi, PW-TDI echocardiographic study was performed. At 1-year follow-up, the composite of major adverse cardiovascular events (MACE) defined as all-cause mortality plus hospitalizations for stroke/systemic embolism was evaluated. Seventy-two patients (77.1 ± 13.1 year/old, 32 males) were studied. All thrombi were located at the LV apex. At 1-year follow-up, 17 cardioembolic events occurred. By univariable Cox analysis, variables associated with MACE were heart rate (hazard ratio: 1.02, 95% CI: 1.00-1.05; P = .03), thrombi with mobile free edge (hazard ratio: 3.25, 95% CI: 1.25-8.44; P = .01), hypoechoic thrombi (hazard ratio: 2.86, 95% CI: 1.10-7.42; P = .03), and mass peak antegrade velocity (Va) ≥10 cm/s (hazard ratio: 8.79, 95% CI: 2.00-38.5; P = .004). By multivariable analysis, thrombi with mobile free edge (hazard ratio: 3.54, 95% CI: 1.23-10.2; P = .02), and mass peak Va ≥10 cm/s (hazard ratio: 7.97, 95% CI: 1.60-39.6; P = .01) retained statistical significance. Mass peak Va ≥10 cm/s predicted the composite end point with 94% sensitivity and 85% specificity (area under the curve = 0.86). In conclusion, PW-TDI allows objective prognostication of LV thrombi embolic risk.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | | | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, MultiMedica IRCCS, Sesto San Giovanni (MI), Italy
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia," Perugia, Italy
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17
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Sultan FAT, Ahmed SW. Cardiac Magnetic Resonance Evaluation of Cardiac Masses in Patients with Suspicion of Cardiac Masses on Echo or Computed Tomography. J Clin Imaging Sci 2020; 10:57. [PMID: 33024612 PMCID: PMC7533085 DOI: 10.25259/jcis_137_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/30/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: In recent years, cardiac magnetic resonance (CMR) imaging has emerged as an important tool in the identification and characterization of cardiac masses. No imaging data on cardiac masses are available from Pakistan. We aimed to review the clinical presentation, CMR findings, and outcome of patients referred for CMR due to suspicion of cardiac masses on echocardiogram or computed tomography (CT). Material and Methods: We reviewed all the patients referred for CMR at Aga Khan University Hospital, Karachi, from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Only those with the confirmed diagnosis of cardiac mass on CMR were included in the study. Results: A total of 27 patients were referred for CMR from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Four patients were excluded as no cardiac mass was found on CMR. Out of 23 cases, majority (n = 15, 65%) were female, age ranging from 3 months to 70 years, with a mean age of 40 ± 22 years. Shortness of breath was the main presenting symptom (n = 19, 83%). Echocardiogram was the initial imaging modality done in all the patients while CT was also performed in 6 patients (26%). Out of 23 patients, 4 (17%) were diagnosed to have thrombus on CMR. In two cases, it was in the left ventricle with evidence of myocardial infarction on late gadolinium images. Myxoma was the most common tumor diagnosed on CMR in 6 patients (26%) followed by rhabdomyoma (n = 3, 13%) and fibroma (n = 2, 8.7%). There were three malignant primary tumors of the heart based on CMR appearances and one with tumor thrombus extension of hepatocellular carcinoma in the right atrium from inferior vena cava. Two patients were diagnosed to have non-neoplastic lesions – one with large intracardiac hydatid cyst and one with possible large fungal vegetation. Among 23 patients, 9 patients (39%) underwent surgery, 5 with myxoma, 2 with rhabdomyoma, 1 with fibroma, and 1 with fibroelastoma. Findings on surgery and histopathology matched the CMR diagnosis in all the patients except the one with the CMR diagnosis of myxoma in which histopathology was consistent with thrombus. Conclusion: CMR can play an important role in confirming the presence or absence of a mass in the heart. It can also provide differentiation of non-neoplastic and neoplastic lesions and among different types of neoplastic lesions with reasonable accuracy. However, the limitations of CMR must be recognized.
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Affiliation(s)
- Fateh Ali Tipoo Sultan
- Department of Medicine (Cardiology), Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Syed Waqar Ahmed
- Department of Medicine (Cardiology), Aga Khan University Hospital, Karachi, Sindh, Pakistan
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18
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Vani A, Ahluwalia M, Donnino R, Jung A, Vaynblat M, Latson L, Saric M. A case of nonvalvular endocarditis with biventricular apical infected thrombi. Echocardiography 2020; 37:1072-1076. [PMID: 32654168 DOI: 10.1111/echo.14690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022] Open
Abstract
We report what appears to be the first case of biopsy-proven nonvalvular endocarditis with biventricular apical infected thrombi. A 47-year-old man presented with hypoxic respiratory failure from a multilobar pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). Transthoracic echocardiography and cardiac magnetic resonance imaging revealed biventricular apical masses suggestive of nonvalvular endocarditis with infected thrombi. Given concern for ongoing septic embolization to the lungs and brain despite appropriate antimicrobial therapy, the masses were surgically resected. Culture and histopathology confirmed MRSA-positive infected thrombi. In this case report, we highlight the differential diagnosis of apical masses and the role of multimodality imaging.
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Affiliation(s)
- Anish Vani
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Monica Ahluwalia
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA.,Department of Radiology, New York University Langone Health, New York, NY, USA.,Veterans Affairs New York Harbor Healthcare System, New York, NY, USA
| | - Albert Jung
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Mikhail Vaynblat
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Larry Latson
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
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19
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Seghatol-Eslami F, Farris GR, Chapman GD, Lloyd SG, Siegal GP. A Rare Cause of Left Atrial Mass. ACTA ACUST UNITED AC 2020; 4:260-262. [PMID: 32875192 PMCID: PMC7451912 DOI: 10.1016/j.case.2020.04.004] [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] [Indexed: 11/18/2022]
Abstract
LAIH may be a complication of blunt chest trauma. Multimodality imaging with TEE and CMR can lead to the correct diagnosis. Conservative management may be considered in hemodynamically stable patients.
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Affiliation(s)
- Frank Seghatol-Eslami
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary Ross Farris
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory D Chapman
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven G Lloyd
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gene P Siegal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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20
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Obstructive right ventricular outflow tract myxosarcoma in an adult dog. J Vet Cardiol 2020; 29:47-53. [PMID: 32464578 DOI: 10.1016/j.jvc.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 11/23/2022]
Abstract
An 8-year-old female spayed German Shepherd cross was presented for acute onset of respiratory distress. Four days before presentation, the owner noticed a reduced appetite and reluctance to move. Clinical examination identified muffled lung sounds and a left base, diamond-shaped systolic murmur graded 4/6. Echocardiography identified pleural and pericardial effusion, ascites and a myxoid mass (39 mm/18.9 mm) obstructing the right ventricular outflow tract and interfering with the pulmonary valve function. Given the poor prognosis, the dog was euthanatised, and a postmortem examination was performed. Grossly, a mass with a heterogeneous appearance was identified below the pulmonary valve leaflets. Based on histopathological and immunohistochemical findings, a diagnosis of intracardiac myxosarcoma affecting the subvalvular region of the pulmonary artery was made. To the author's knowledge, this is the first report of right ventricle out flow tract myxosarcoma in the canine species.
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21
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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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22
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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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23
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Abstract
Soft-tissue masses or mass-like lesions involving the mitral valve include a wide range of diseases such as tumors, abscesses, vegetations, thrombus and, rarely, caseous calcifications of the mitral annulus. Caseous calcifications of the mitral annulus is a rare variant of mitral annular calcification that is usually asymptomatic and diagnosed incidentally. Echocardiography is the first-choice imaging modality. Cardiac computed tomography is an ideal tool to confirm the presence of calcifications and caseous necrosis. In cases where there is doubt, cardiac magnetic resonance imaging may be used. We present the case of a 62-year-old patient with an intra-cardiac mass diagnosed by echocardiography. Imaging modalities to achieve a correct diagnosis and avoid unnecessary surgical intervention are discussed.
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Affiliation(s)
- Silvia Pradella
- Department of Radiology, AOU Careggi Hospital, Florence, Italy
| | - Silvia Verna
- Department of Radiology, AOU Careggi Hospital, Florence, Italy
| | - Gloria Addeo
- Department of Radiology, AOU Careggi Hospital, Florence, Italy
| | - Andrea Oddo
- Dipartimento Cardiotoracovascolare, SOD Diagnostica Cardiovascolare, AOU Careggi Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, AOU Careggi Hospital, Florence, Italy
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24
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Luo C, Zhu J, Bao C, Ding F, Mei J. Minimally invasive and conventional surgical treatment of primary benign cardiac tumors. J Cardiothorac Surg 2019; 14:76. [PMID: 30971259 PMCID: PMC6458600 DOI: 10.1186/s13019-019-0890-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/01/2019] [Indexed: 01/14/2023] Open
Abstract
Background Primary cardiac tumors are rare and the majorities are benign. Conventional surgical treatment uses median sternotomy, while minimally invasive surgery from right anterolateral minithoracotomy has become an alternative method in recent years. In this study, we summarized the surgical outcomes of both approaches. Methods From January 2008 to August 2018, 50 patients with primary benign cardiac tumors underwent either conventional or minimally invasive surgery in our department. The baseline data were collected. The peri-operative data and follow up results were compared between the two groups. Results There were19 men and 31 women enrolled in this study with a mean age of 55.0 ± 17.5 years. The most common site of the tumor was left atrium (n = 40, 80%), followed by right atrium (n = 8, 16.0%), right ventricle (n = 1, 2.0%) and left ventricle (n = 1, 2.0%). All patients underwent surgery uneventfully, including 33 cases (66.0%) of median sternotomy and 17 cases (34.0%) of right anterolateral minithoracotomy. No significant differences were found between the two groups in terms of cardiopulmonary bypass time, aortic cross-clamp time, postoperative intubation time, intensive care unit days and length of the hospital stay. Patients with right anterolateral minithoracotomy had less post-operative chest drainage (536 ± 159 vs 773 ± 255 ml, P < 0.01) and transfusion rate (5.9% vs 33.3%, P = 0.033) than those who had sternotomy. There was no peri-operative death, and all the patients were alive and free of recurrence at the latest follow-up. Conclusions Surgical resection of primary benign cardiac tumors is safe, effective and durable. The right anterolateral minithoracotomy provides the same postoperative recovery as standard median sternotomy, but less transfusion. It can be considered as a promising alternative approach.
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Affiliation(s)
- Congcong Luo
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Jiaquan Zhu
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Chunrong Bao
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Fangbao Ding
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
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25
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Demir V, Turan Y, Ede H, Hidayet S, Erkoç MF. Electrocardiographic changes in right ventricular metastatic cardiac tumor mimicking acute ST elevation myocardial infarction: A case of misdiagnosis. Turk J Emerg Med 2019; 19:33-35. [PMID: 30793064 PMCID: PMC6370910 DOI: 10.1016/j.tjem.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In patients with ST elevation myocardial infarction (STEMI), minimizing the reperfusion time is the goal of therapy worldwide. However, the differential diagnosis is critical and when a patient is encountered with chest pain and ST elevation, STEMI should not be the only diagnosis considered. By detailed history and focused physical examination, it is possible to avoid a mistaken diagnosis. CASE PRESENTATION In this report, we present a case of a male patient with tongue cancer and accompanying myocardial metastasis that causes electrocardiographic changes, who was initially misdiagnosed with ST elevation myocardial infarction. CONCLUSION Here, we reported a case of metastatic cancer in the heart which was initially diagnosed as acute myocardial infarction. Echocardiography, computed tomography and magnetic resonance imaging of the heart were used accordingly to confirm the myocardial metastasis.
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Affiliation(s)
- Vahit Demir
- Department of Cardiology, Medical Faculty of Bozok University, Adnan Menderes Bulvarı No:44, 66020, Yozgat, Turkey
| | - Yasar Turan
- Department of Cardiology, Medical Faculty of Bozok University, Adnan Menderes Bulvarı No:44, 66020, Yozgat, Turkey
| | - Hüseyin Ede
- Department of Cardiology, Medical Faculty of Bozok University, Adnan Menderes Bulvarı No:44, 66020, Yozgat, Turkey
| | - Siho Hidayet
- Department of Cardiology, Medical Faculty of Bozok University, Adnan Menderes Bulvarı No:44, 66020, Yozgat, Turkey
| | - Mustafa F. Erkoç
- Department of Radiology, Medical Faculty of Bozok University, Adnan Menderes Bulvarı No:44, 66020, Yozgat, Turkey
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26
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Abels B, Pfeiffer S, Stix J, Schwab J. Multimodal Imaging for the Assessment of a Cardiac Mass - A Case of Primary Cardiac Sarcoma. J Radiol Case Rep 2018; 11:11-19. [PMID: 29296166 DOI: 10.3941/jrcr.v11i11.3194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of an 85-year-old patient who underwent clinical work-up for chronic heart failure, acute coronary syndrome, and pulmonary embolism, until she was diagnosed with a cardiac mass that was histologically identified as sarcoma. The aim of this educational case report is to raise awareness of cardiac masses and to point out diagnostic hints towards a cardiac tumor on chest X-ray, coronary angiography, echocardiography, and chest CT. Moreover, the vital role of cardiac magnetic resonance for the diagnosis of a cardiac mass is highlighted.
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Affiliation(s)
- Benjamin Abels
- Institute of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuremberg General Hospital, Germany
| | - Steffen Pfeiffer
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg General Hospital, Germany
| | - Jana Stix
- Institute of Pathology, Paracelsus Medical University, Nuremberg General Hospital, Germany
| | - Johannes Schwab
- Institute of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuremberg General Hospital, Germany
- Department of Cardiology, Internal Medicine 8, Paracelsus Medical University, Nuremberg General Hospital, Germany
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27
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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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Tse CS, Tan N, Idossa D, Click R. Cardiac melanoma: Retrospective review of a rare disease at the Mayo clinic (1988-2015). Int J Cardiol 2017; 249:383-386. [PMID: 28923551 DOI: 10.1016/j.ijcard.2017.08.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Melanoma metastasizing to the heart (cardiac melanoma) is a rare entity that has been described only in autopsy studies or isolated pre-mortem case reports. We aim to better characterize cardiac melanoma, and describe its presenting features, imaging findings, and disease course with a case series collected over nearly 30years. METHODS We performed a retrospective review of all patients diagnosed with cardiac melanoma at the Mayo Clinic from 1988 to 2015. Qualitative analysis was performed on patient demographics, clinical history, and imaging modalities. RESULTS 11 patients (7 male, median age 63years) were identified with cardiac melanoma. Shortness of breath (64%) was the most common presenting symptom. Transthoracic echocardiography (TTE) was utilized in the assessment of all patients though it failed to identify 20% of masses that were seen on fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) or cardiac magnetic resonance (CMR). The majority of masses were located within the cardiac chambers (46% right atrium, 18% right ventricle, 18% left atrium), and 36% appeared mobile on TTE. Patients lived for a median of 68months (interquartile range [IQR] 14-143months) after the initial diagnosis of primary melanoma, and only 12months (IQR 2-150months) after diagnosis of cardiac melanoma. CONCLUSION Echocardiography can generally identify most cases of cardiac melanoma, though it misses one-fifth of masses seen on FDG PET/CT or CMR. Cardiac melanoma is associated with a poor prognosis.
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Affiliation(s)
- Chung Sang Tse
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicholas Tan
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dame Idossa
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Roger Click
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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Reddy G, Maor E, Bois M, Chandrasekharan K, Rihal C, Nishimura R, Holmes D, Reeder G, Maleszewski J, Klarich K. Percutaneous transcatheter biopsy for intracardiac mass diagnosis. EUROINTERVENTION 2017; 13:e1436-e1443. [DOI: 10.4244/eij-d-17-00707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nomoto N, Tani T, Konda T, Kim K, Kitai T, Ota M, Kaji S, Imai Y, Okada Y, Furukawa Y. Primary and metastatic cardiac tumors: echocardiographic diagnosis, treatment and prognosis in a 15-years single center study. J Cardiothorac Surg 2017; 12:103. [PMID: 29183343 PMCID: PMC5704631 DOI: 10.1186/s13019-017-0672-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 11/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The frequency of primary cardiac tumors is rare at about 0.3% by autopsy. Our objective was to investigate the characteristics and locations of cardiac tumors and to provide a prognostic analysis in our hospital. METHODS We collected data on 95 patients with echocardiographic diagnosis or detection of cardiac tumors in a prospective analysis from 1999 to 2014. The median follow-up period was 43 months (0.5-183 months). RESULTS The subjects included 56 men and 39 women with a mean age of 65 years. Clinical diagnosis revealed primary tumors in 61 patients (64%) and secondary metastatic tumors in 34 patients (36%). In the 61 patients, 41 patients (67%) underwent surgery and tissue samples were obtained. Of these 41 patients, benign tumors were found in 30 cases (73%). One patient (2%) was diagnosed with thrombus. Among the benign tumors, myxoma (67%) was the most common type followed by papillary fibroelastoma (23%). The most common site was the left atrium (35%) followed by the right atrium (25%). Primary malignant tumors were diagnosed in 10 cases (24%), including 6 angiosarcomas, 3 lymphomas, and 1 leiomyosarcoma. The diagnostic accuracy of echocardiography was 80%. The patients with benign tumors were all alive at the end of the follow-up period. In contrast, 7 patients with malignant tumors died (70%) (p < 0.0001). CONCLUSIONS Our data is in line with previous literature. Our study also suggests the necessity of extending our knowledge of the characteristics of cardiac tumors for diagnosis.
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Affiliation(s)
- Natsumi Nomoto
- Department of Clinical Technology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Tomoko Tani
- Basic Medical Science, Kobe City College of Nursing, 3-4 Gakuennishi-machi, Nishi-ku, Kobe, 651-2103, Japan.
| | - Toshiko Konda
- Department of Clinical Technology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Mitsuhiko Ota
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yukikatsu Okada
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
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Cystic mass in the left ventricle: suspected thrombus with inhomogeneous appearance. Int J Cardiovasc Imaging 2017; 33:1149-1150. [PMID: 28220274 DOI: 10.1007/s10554-017-1096-0] [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: 01/24/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
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Schäfer HM, Isaak A, Gürke L. Case report of an intracaval leiomyomatosis 10 months after complete hysterectomy. Int J Surg Case Rep 2017; 35:1-3. [PMID: 28414995 PMCID: PMC5394212 DOI: 10.1016/j.ijscr.2017.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 11/27/2022] Open
Abstract
Intravenous leiomyomatosis within the vena cava can spread rapidly as far proximally as intracardially. Intravenous leiomyomatosis can be removed bluntly through cavotomy. Sternotomy can be avoided, reducing the surgery to a laparotomy.
Introduction Intravenous leiomyomatosis (IVL) is a rare smooth muscle tumor, usually found in women with tumors of the reproductive organs, such as uterus myomatosous. Surgically, this case belies the call for sternotomy and two-stage surgery in caval IVL extending to the right atrium: we suggest one-stage median laparotomy as a minimal procedure with maximal benefit. Presentation of case We present the case of a 60-year-old postmenopausal woman with suspected intravenous leiomyomatosis of the right internal iliac vein. The patient had undergone hysterectomy and bilateral adnexectomy for uterus myomatosous in September 2015, where an IVL limited to the veins of the uterus and the right adnex had been diagnosed. No further medical treatment had been implemented. IVL of the inferior vena cava was diagnosed when a CT scan of the abdomen was performed due to an infected abdominal seroma in June 2016. Although histologically benign, we found this case of IVL to be clinically aggressive because of its expansion to the heart. This may lead to thromboembolic complications (e.g. pulmonary embolism) or signs of right sided cardiac failure. The patient was asymptomatic, but because of the extension of the intracaval thrombus to the heart, we decided to operate and performed thrombectomy via a median laparotomy. The patient left the hospital shortly after on newly started oral anticoagulation. Discussion For caval IVL without intracardiac attachment, the extraction via laparotomy without sternotomy is the treatment of choice. It calls for an interdisciplinary approach and careful surgical planning. Conclusion There is no inherent need for sternotomy in IVL extending to the right atrium. A one-year follow-up with sonographic control is advised. Medium term oral anticoagulation should be considered. This work has been reported in line with the SCARE criteria Agha et al. (2016). The SCARE Statement: Consensus-based surgical case report guidelines. Agha RA, Fowler AJ, Saeta A, Barai I, Rajmohan S, Orgill DP; SCARE Group. Int J Surg. 2016 Oct;34:180-186 [1].
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Affiliation(s)
| | - Andrej Isaak
- University Hospital Basel, Vascular Surgery, Switzerland.
| | - Lorenz Gürke
- University Hospital Basel, Vascular Surgery, Switzerland.
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Dinesh Kumar US, Shetty SP, Sujay KR, Wali M. Left ventricular mass: A tumor or a thrombus diagnostic dilemma. Ann Card Anaesth 2017; 19:728-732. [PMID: 27716707 PMCID: PMC5070336 DOI: 10.4103/0971-9784.191551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Left ventricular (LV) mass is a rare condition, of which the most common is thrombus. Echocardiography is a very useful modality of investigation to evaluate the LV mass. We are reporting a case of LV mass presenting with neurological symptom. The diagnosis of this mass was dilemma as the echocardiographic features were favoring tumor as well as thrombi. Mass (a) measuring 3.8 cm × 1.9 cm attached to the left ventricle apex appeared to be pedunculated tumor and mass (b) measuring 2.4 cm × 1.8 cm attached to the chordae of anterior mitral leaflet resembled a thrombus or an embolized tumor entangled in the chordae. A differential diagnosis for the LV mass is thrombus, tumors such as fibroma, and vegetation. Preoperative detection of a thrombus leads to an alteration in surgical steps. A large and mobile thrombus with or without a hemodynamic alteration is an indication for surgical removal to prevent stroke, myocardial infarction, mesenteric ischemia, renal infarction, gangrene of the limbs, and mortality.
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Affiliation(s)
- U S Dinesh Kumar
- Department of Cardiac Thoracic and Vascular Anesthesia, JSS Super Speciality Hospital and Medical College, Mysore, Karnataka, India
| | - Shyam Prasad Shetty
- Department of Cardio Vascular and Thoracic Surgery, JSS Super Speciality Hospital and Medical College, Mysore, Karnataka, India
| | - K R Sujay
- Department of Cardio Vascular and Thoracic Surgery, JSS Super Speciality Hospital and Medical College, Mysore, Karnataka, India
| | - Murugesh Wali
- Department of Cardiac Thoracic and Vascular Anesthesia, JSS Super Speciality Hospital and Medical College, Mysore, Karnataka, India
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Dendramis G, Di Lisi D, Paleologo C, Novo G, Novo S. Large left ventricular metastasis in patient with liposarcoma. J Cardiovasc Med (Hagerstown) 2016; 17 Suppl 2:e166-e168. [DOI: 10.2459/jcm.0000000000000176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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35
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Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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Affiliation(s)
- Muhamed Saric
- New York University Langone Medical Center, New York, New York
| | | | - M Samir Arnaout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farooq A Chaudhry
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Richard A Grimm
- Learner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Kirsten Tolstrup
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Macura O, Paleček T, Hlubocký J, Vondráček P, Vítková I, Kuchař J, Hlubocká Z. Papillary fibroelastoma originating from the free left ventricular wall as the cause of recurrent stroke: Description of the case and literature review. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Vakilian F, Shabestari MM, Poorzand H, Teshnizi MA, Allahyari A, Memar B. Primary Pulmonary Valve Leiomyosarcoma in a 35-Year-Old Woman. Tex Heart Inst J 2016; 43:84-7. [PMID: 27047294 DOI: 10.14503/thij-14-4748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary cardiac leiomyosarcomas are rare, with a high incidence of local recurrence. Herein, we report the case of a 35-year-old woman who was admitted with right ventricular failure and suspected pulmonary embolism. Upon echocardiography, we detected a mass in the pulmonary trunk that involved the pulmonary valve and led to valvular stenosis. The optimal protocol for treating these tumors is as yet unclear. Complete resection can rarely be achieved. However, palliative surgery is usually undertaken because many patients present with mechanical obstruction, such as significant pulmonary stenosis.
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39
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Jain S, Maleszewski JJ, Stephenson CR, Klarich KW. Current diagnosis and management of cardiac myxomas. Expert Rev Cardiovasc Ther 2015; 13:369-75. [PMID: 25797902 DOI: 10.1586/14779072.2015.1024108] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac myxoma is the most common cardiac neoplasm. In the majority of cases, it is isolated (non-syndromic) and located in the left atrium. In up to 10% cases, it is seen in syndromic association with the Carney complex where it is encountered in younger patients, with atypical and multiple locations, such as the right atrium or ventricles, and carries a high risk of recurrence. Imaging is pivotal in the diagnosis, management guidance and surveillance. Surgical excision is the established definitive treatment. Further research should address management strategies in incidentally discovered small myxomas in asymptomatic patients and the role of genetic testing and screening in syndromic myxomas.
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Affiliation(s)
- Sonia Jain
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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40
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Gierlak W, Syska-Sumińska J, Zieliński P, Dłużniewski M, Sadowski J. Cardiac tumors: leiomyosarcoma - a case report. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2015; 12:251-4. [PMID: 26702284 PMCID: PMC4631920 DOI: 10.5114/kitp.2015.54464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 05/07/2013] [Accepted: 02/11/2014] [Indexed: 11/25/2022]
Abstract
We present a case report of a 60-year-old woman with a long history of leiomyosarcoma in different locations. She was admitted to the clinic due to a left ventricular tumor diagnosed in ECHO examination. The patient was qualified for radical tumor resection. The early postoperative period was complicated due to low cardiac output syndrome and bradyarrhythmia requiring temporary cardiac pacing. Optimized pharmacological therapy resulted in a gradual reduction of symptoms and a clinical improvement of congestive heart failure (NYHA III - NYHA II). Due to the radical nature of the surgery, the patient was not referred for supplementary treatment. The follow-up currently exceeds 12 months - no new metastases have been found. This case provides an example of how to diagnose and treat heart tumors.
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Affiliation(s)
- Włodzimierz Gierlak
- Department of Cardiology, Hypertension, and Internal Diseases, Second Faculty of Medicine, Medical University of Warsaw, Bródnowski Masovian Hospital, Warsaw, Poland
| | - Joanna Syska-Sumińska
- Department of Cardiology, Hypertension, and Internal Diseases, Second Faculty of Medicine, Medical University of Warsaw, Bródnowski Masovian Hospital, Warsaw, Poland
| | - Piotr Zieliński
- Department of Cardiology, Hypertension, and Internal Diseases, Second Faculty of Medicine, Medical University of Warsaw, Bródnowski Masovian Hospital, Warsaw, Poland
| | - Mirosław Dłużniewski
- Department of Cardiology, Hypertension, and Internal Diseases, Second Faculty of Medicine, Medical University of Warsaw, Bródnowski Masovian Hospital, Warsaw, Poland
| | - Jerzy Sadowski
- Department of Cardiovascular Surgery and Transplantation, Institute of Cardiology, Collegium Medicum of the Jagiellonian University, Pope John Paul II Hospital in Krakow, Poland
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Lestuzzi C, De Paoli A, Baresic T, Miolo G, Buonadonna A. Malignant cardiac tumors: diagnosis and treatment. Future Cardiol 2015; 11:485-500. [DOI: 10.2217/fca.15.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Primary malignant cardiac tumors are represented by sarcomas and non-Hodgkin lymphomas. They are rare, affect mostly patients in the fourth decade of life and have a severe prognosis. Both the diagnosis and the treatment require a multidisciplinary approach, and the cardiologist plays a central role both in the diagnosis and in the follow-up. The prognosis may be improved by a careful planning of surgery and by the use of multimodality treatment, including complementary chemotherapy and radiation therapy. A strict follow-up must be planned even after apparently complete cure.
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Affiliation(s)
- Chiara Lestuzzi
- Cardiology Unit, Oncology Department, CRO, National Cancer Institute (IRCCS), Aviano (PN), Italy
| | - Antonino De Paoli
- Radiation Oncology Department, CRO, National Cancer Institute (IRCCS), Aviano (PN), Italy
| | - Tanja Baresic
- Nuclear Medicine Unit, CRO, National Cancer Institute (IRCCS), Via F Gallini 2, 33081, Aviano (PN), Italy
| | - Gianmaria Miolo
- Medical Oncology, Oncology Department, CRO, National Cancer Institute (IRCCS), Aviano (PN), Italy
| | - Angela Buonadonna
- Medical Oncology, Oncology Department, CRO, National Cancer Institute (IRCCS), Aviano (PN), Italy
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Uenishi EK, Caldas MA, Tsutsui JM, Abduch MCD, Sbano JCN, Kalil Filho R, Mathias W. Evaluation of cardiac masses by real-time perfusion imaging echocardiography. Cardiovasc Ultrasound 2015; 13:23. [PMID: 25933602 PMCID: PMC4424545 DOI: 10.1186/s12947-015-0018-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Diagnosis of cardiac masses is still challenging by echocardiography and distinguishing tumors from thrombi has important therapeutical implications. We sought to determine the diagnostic value of real-time perfusion echocardiography (RTPE) for cardiac masses characterization. Methods We prospectively studied 86 patients, 23 with malignant tumors (MT), 26 with benign tumors (BT), 33 with thrombi and 6 with pseudotumors who underwent RTPE. Mass perfusion was analyzed qualitatively and blood flow volume (A), blood flow velocity (β), and microvascular blood flow (A x β) were determined by quantitative RTPE. Results Logistic regression models showed that the probability of having a tumor increased by 15.8 times with a peripheral qualitative perfusion pattern, and 34.5 times with a central perfusion pattern, in comparison with the absence of perfusion. Using quantitative RTPE analysis, thrombi group had parameters of blood flow lower than tumor group. A values for thrombi, MT, and BT were 0.1 dB (0.01-0.22), 2.78 dB (1–7) and 2.58 dB (1.44-5), respectively; p < 0.05, while A x β values were 0.0 dB/s−1 (0.01–0.14), 2.00 dB/s−1 (1–6), and 1.18 dB/s−1 (0.52–3), respectively; p < 0.05. At peak dipyridamole stress, MT had greater microvascular blood volume than BT [A = 4.18 dB (2.14-7.93) versus A = 2.04 dB (1.09-3.55); p < 0.05], but no difference in blood flow [Axβ = 2.46 dB/s−1 (1.42–4.59) versus Axβ = 1.55 dB/s [1] (0.51-4.08); p = NS]. An A value >3.28 dB at peak dipyridamole stress predicted MT (AUC = 0.75) and conferred 5.8-times higher chance of being MT rather than BT. Conclusion RTPE demonstrated that cardiac tumors have greater microvascular blood volume and regional blood flow when compared with thrombi. Dipyridamole stress was useful in differentiating MT from BT.
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Affiliation(s)
- Eliza K Uenishi
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Márcia A Caldas
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Jeane M Tsutsui
- Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil.
| | - Maria C D Abduch
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - João C N Sbano
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil.
| | - Wilson Mathias
- Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil.
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Calissendorff J, Maret E, Sundin A, Falhammar H. Ileal neuroendocrine tumors and heart: not only valvular consequences. Endocrine 2015; 48:743-55. [PMID: 25319177 DOI: 10.1007/s12020-014-0446-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/01/2014] [Indexed: 12/11/2022]
Abstract
Ileal neuroendocrine tumors (NETs) often progress slowly, but because of their generally nonspecific symptoms, they have often metastasized to local lymph nodes and to the liver by the time the patient presents. Biochemically, most of these patients have increased levels of whole blood serotonin, urinary 5-hydroxyindoleacetic acid, and chromogranin A. Imaging work-up generally comprises computed tomography or magnetic resonance imaging and somatostatin receptor scintigraphy, or in recent years positron emission tomography with 68Ga-labeled somatostatin analogs, allowing for detection of even sub-cm lesions. Carcinoid heart disease with affected leaflets, mainly to the right side of the heart, is a well-known complication and patients routinely undergo echocardiography to diagnose and monitor this. Multitasking surgery is currently recognized as first-line treatment for ileal NETs with metastases and carcinoid heart disease. Open heart surgery and valve replacement are advocated in patients with valvular disease and progressive heart failure. When valvulopathy in the tricuspid valve results in right-sided heart failure, a sequential approach, performing valve replacement first before intra-abdominal tumor-reductive procedures are conducted, reduces the risk of bleeding. Metastases to the myocardium from ileal NETs are seen in <1-4.3% of patients, depending partly on the imaging technique used, and are generally discovered in those affected with widespread disease. Systemic treatment with somatostatin analogs, and sometimes alpha interferon, is first-line medical therapy in metastatic disease to relieve hormonal symptoms and stabilize the tumor. This treatment is also indicated when heart metastases are detected, with the addition of diuretics and fluid restriction in cases of heart failure. Myocardial metastases are rarely treated by surgical resection.
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Affiliation(s)
- Jan Calissendorff
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden,
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Bouabdallaoui N, Nader M, Leprince P. Uncommon cause of intracardiac thrombus. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:527-528. [PMID: 25746944 DOI: 10.1177/2048872615576220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/08/2015] [Indexed: 11/15/2022]
Abstract
We present a rare image documenting direct transit of a thrombus originating from the venous circulation and passing through a patent foramen ovale linked to a malpositioned cannula in the setting of temporary mechanical circulatory assistance in a young patient who underwent a peripheral extra corporeal membrane oxygenation as a circulatory support.
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Affiliation(s)
- Nadia Bouabdallaoui
- Department of Thoracic and Cardiovascular Surgery, University Pierre et Marie Curie, Paris VI, Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, France
| | - Marwan Nader
- Department of Anaesthesiology, University Pierre et Marie Curie, Paris VI, Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, France
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery, University Pierre et Marie Curie, Paris VI, Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, France
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45
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Dilek M, Kaya C, Karatas A, Ozer I, Arık N, Gulel O. Catheter-related atrial thrombus: tip of the iceberg? Ren Fail 2015; 37:567-71. [PMID: 25694191 DOI: 10.3109/0886022x.2015.1007461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although guidelines recommend catheters as a last resort for establishing a vascular access in patients undergoing dialysis, they continue to be used widely for this purpose. Catheter-related atrial thrombus (CRAT) is rarely reported in this group of patients, and it can lead to serious complications. The aim of this study was to determine the incidence of CRAT in patients undergoing hemodialysis with permanent-tunneled catheters. A total of 50 patients undergoing hemodialysis with permanent catheters were included in this study. The diagnosis of CRAT was based on transthoracic echocardiography findings. Thrombus was present in nine patients (18%) and related to the tip of the catheter in all cases. Except for one patient with two foci of thrombus, all patients had a single focus. There were no significant associations between the development of thrombus and the duration of catheter use or the location of the catheter. Furthermore, catheter-related atrial thrombus did not appear to have a significant effect on mortality. The asymptomatic character of CRAT can be responsible for the low reporting rates, and its exact role in increased mortality and morbidity related with catheter use remains unknown. While planning management strategies, information on different options for vascular access routes and possible catheter-related complications should be provided to all patients who will undergo dialysis, together with a discussion involving other replacement alternatives for end-stage renal disease.
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Affiliation(s)
- Melda Dilek
- Department of Nephrology, Ondokuz Mayıs University School of Medicine , Samsun , Turkey
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46
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Intravenous leiomyomatosis: A rare cause of intracardiac mass. Rev Port Cardiol 2014; 33:735.e1-5. [DOI: 10.1016/j.repc.2014.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/30/2014] [Accepted: 04/27/2014] [Indexed: 11/17/2022] Open
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Cruz I, João I, Stuart B, Iala M, Bento L, Cotrim C, Nobre Â, Pereira H. Intravenous leiomyomatosis: A rare cause of intracardiac mass. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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48
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Di Michele S, Mirabelli F, Galzerano D, Mankad S. An unusual myocardial infarction. Echo Res Pract 2014; 1:K9-K12. [PMID: 26693309 PMCID: PMC4676451 DOI: 10.1530/erp-14-0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 10/13/2014] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED We present a 74-year-old male with a chondrosarcoma, who presented with chest pain. The history, electrocardiogram (ECG), and biomarkers established the diagnosis of myocardial infarction (MI); angiography did not show coronary atherosclerosis and, both initial transthoracic echocardiogram and chest computed tomography (CT), did not demonstrate any cardiac abnormalities. A second echocardiogram following a routine ECG showed presence of a mass involving the right ventricle and the cardiac apex that was confirmed by chest CT scan. We underline the importance of considering cardiac tumors in the clinical arena of MI management. LEARNING POINTS Cardiac tumors cause ECG changes similar to ischemic heart diseases.Keep in mind cardiac tumors when performing transthoracic echocardiogram (TTE) in the setting of suspected MI.TTE is the technique of choice in detecting cardiac tumors.
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Affiliation(s)
- Sara Di Michele
- Department of Heart and Great Vessels 'A. Reale', La Sapienza University , Rome , Italy
| | - Francesca Mirabelli
- Department of Heart and Great Vessels 'A. Reale', La Sapienza University , Rome , Italy
| | | | - Sunil Mankad
- Department of Cardiovascular Disease, Mayo Clinic , Rochester, Minnesota , USA
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49
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Li R, Shen Y, Sun Y, Zhang C, Yang Y, Yang J, Su R, Jiang B. Intravenous leiomyomatosis with intracardiac extension: echocardiographic study and literature review. Tex Heart Inst J 2014; 41:502-6. [PMID: 25425982 DOI: 10.14503/thij-13-3533] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Uterine leiomyomatosis is a common disease in women; however, intravenous leiomyomatosis with intracaval and intracardiac tumor extension is rare. We sought to analyze the clinical and echocardiographic features of intracardiac leiomyomatosis. From January 2003 through July 2012, 7 women (age range, 24-59 yr) underwent surgical resection of histopathologically diagnosed intracardiac leiomyomas at our hospital. Most of the patients had histories of hysterectomy or uterine leiomyoma. We retrospectively analyzed their preoperative echocardiograms. We found that the tumors had no stalks, did not adhere to the wall of the right side of the heart, were highly mobile, and moved back and forth in the right atrium near the tricuspid orifice. All tumors originated from the inferior vena cava and had borders well demarcated from that structure's wall. Most of the masses extended into the inferior vena cava and right atrium through the right internal and common iliac veins. Computed tomograms revealed pelvic tumors and contiguous filling defects in 6 patients. When echocardiograms reveal a right-sided cardiac mass that originates from the inferior vena cava, particularly in women who have a history of hysterectomy or uterine leiomyoma, intracardiac leiomyomatosis should be suspected. If the mass has no stalk and freely moves within the inferior vena cava and right-sided cardiac chambers without attachment to the endothelial surface or endocardium, intracardiac leiomyomatosis should be diagnosed. We discuss our findings and briefly review the relevant medical literature.
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50
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Cavallero E, Curzi M, Cioccarelli SA, Papalia G, Ornaghi D, Bragato RM. An Unusual Left Ventricular Apical Mass. J Cardiovasc Echogr 2014; 24:95-96. [PMID: 28465915 PMCID: PMC5353448 DOI: 10.4103/2211-4122.143986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Left ventricular apical masses constitute a rare finding. Imaging properties together with the clinical history of the patient usually allow an etiologic definition. We report a challenging case of an ambiguous left ventricular apical mass of uncertain nature till histological examination. Points of interest were singular clinical history and echocardiographic findings, although not conclusive in hypothesis generating. Furthermore to the best of our knowledge, this is one of the rare attempt to excise a deep left ventricular mass with a mini-invasive surgical approach.
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Affiliation(s)
- Erika Cavallero
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mirko Curzi
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Sara Anna Cioccarelli
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giulio Papalia
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Diego Ornaghi
- Heart Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Renato Maria Bragato
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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