Bileaflet blood cysts on the mitral valve in an adult

A rare giant atrial septal cardiac blood cyst in an adult: a case report

Background

Cardiac blood cysts are exceedingly rare cardiac tumours usually found on cardiac valves in infants. We report and discuss a rare unique case wherein a giant atrial septal cardiac blood cyst was found in an adult.

Case summary

A 59-year-old Chinese lady with history of hypertension, hyperlipidemia and transient ischaemic attack presented with atypical chest pain. Her ECG suggested right ventricular strain. Echocardiography revealed a large right atrial intracardiac mass attached to the interatrial septum which prolapsed into the right ventricle during each cardiac cycle with associated dilatation of the right atrium and right ventricle. Computed tomography scans showed no evidence of malignancy or metastasis. Considering our patient's profile and the characteristics of the mass, it was opined to likely be a cardiac myxoma. After consultation with our cardiothoracic surgeons, she underwent surgical resection of the intracardiac mass. Histology revealed that the intracardiac mass was a cardiac blood cyst.

Discussion

First described by Elsasser in 1844, cardiac blood cysts are extremely rare benign cardiac tumours very rarely seen in adults. Though benign, they have been associated with outflow tract obstruction, valvular regurgitation and embolization. Symptomatic patients do well with surgical resection, while long-term outcomes in asymptomatic patients followed up with serial echocardiograms are mixed. Due to its rarity, existing literature is limited to case reports and small case series, with a lack of guidelines on management till recently. Our case report serves to highlight this unique presentation of an exceedingly rare intracardiac tumour.

Case report and literature review: cardiac hematic cyst

A 49-year-old female patient, asymptomatic, presented to the cardiology office for a right atrial mass, identified incidentally in a non-electrocardiogram (ECG)-gated contrast-enhanced computed tomography, performed for follow-up of pulmonary tuberculosis. Echocardiography, surprisingly, showed an anechogenic ovoid mass in the right atrium measuring 40 × 40 mm2, implanted in the interatrial septum without affecting the tricuspid valve. ECG-gated computed tomography angiography (CTA), confirmed the dimensions of the mass, which presented homogeneous content, calcified areas, and a 12-mm pedicle implanted near the ostium of the coronary sinus. Additionally, contrast uptake and infiltration of adjacent structures were ruled out. In the surgical field, an encapsulated mass with blood content was found, which pathology reported as a hematic endocardial cyst (HEC). These are rare cardiac masses, constituting 1.5% of all primary cardiac tumors. It is usually an incidental finding, and its clinical presentation will depend on its dimensions and the intracardiac hemodynamic impact. A highlighting feature is its anechogenic content on ultrasound, however, multimodality imaging allows for making diagnostic assumptions, discerning between primary cardiac tumors, and provides morphological and hemodynamic information useful for therapeutic decision making. The age of the patient, the large size of the HEC, and its location in the interatrial septum make up a completely atypical presentation of this rare disease, which motivated this report.

Congenital Blood Cyst of a Child: A case report and review of literature

Blood-filled cysts of the heart valves are frequently reported at postpartum autopsies of infants. They are seen as round nodules mostly in the paediatric age group in infants less than 2 months of age and disappear spontaneously within 6 months of life. We report a unique case of an 11-month-old girl who presented at a tertiary healthcare hospital in 2022 with a blood-filled cyst on the posterior leaflet of the pulmonary valve that was successfully treated. This case report highlights the characteristics and course of a paediatric patient with blood-filled cysts. Further studies are yet needed to better understand the diagnostic approaches to blood-filled cysts as well as treatment modalities to fill the gap in clinical settings.

Sudden unexpected death from subvalvular hemorrhagic cyst complicated with coronary heart disease in an adult

Cardiac blood cysts are rare benign tumors. It is commonly found in the heart valve and left ventricle of newborns by autopsy and is rarely seen in adults [1, 2]. The typical histopathology of cardiac blood cysts is a closed, round, blood-containing cystic mass attached to the heart valve or endocardium. This article reports a rare case of sudden death due to a giant subaortic cardiac blood cyst with coronary heart disease in an adult patient and summarizes the pathological features, aiming to provide a reference for the forensic pathological identification of cardiac blood cysts.

Mitral valve leaflet blood cyst treated with minimally invasive approach: a case report and review of literature

INTRODUCTION

Cardiac blood cyst is a very rare benign tumor of the heart in adults. Though it is very common in the first half year of life, it regresses with time and its occurrence is very rare in children older than six months and in adults. Until now less than 100 valvular blood cyst cases have been reported in adults.

CASE PRESENTATION

We present a case of a 66-year-old male who presented to us with exertional chest tightness, shortness of breath, and right leg weakness for two weeks. He was diagnosed with a cardiac mass two months ago in another hospital. The physical examination was unremarkable. Abdominal ultrasound showed a cyst in the liver and left kidney. Echocardiography showed a mass-occupying lesion of a cystic nature in the mitral valve with moderate mitral regurgitation. Based on echocardiography findings and computed tomography report, the preliminary diagnosis of mitral valve cystic tumor was made. The patient underwent minimally invasive resection of the cyst. The posterior mitral cusp was repaired and a mitral annuloplasty ring was placed. The postoperative recovery was uneventful. The histopathology report confirmed the diagnosis of a cardiac blood cyst. The patient was followed up for six months without any complications. This case is presented to enrich the medical literature on the cardiac blood cyst.

CONCLUSION

Although a cardiac blood cyst is a rare entity in adults, it still should be considered in the differential diagnosis of cardiac tumors. Because the natural history and hemodynamic effects are very diverse, large symptomatic cardiac blood cysts, especially in the left heart should be resected to avoid complications.

Mitral Valve Blood Cyst Diagnosed with the Use of Multimodality Imaging

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Intracardiac blood cyst is a rare congenital abnormality that can be found in adults.

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It is most commonly attached in the valves, particularly the mitral valve.

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Echocardiography is the imaging modality of choice for the diagnosis of blood cyst.

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Cardiac MRI contributes to the diagnosis, typically showing absence of cyst enhancement.

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Conservative management is reasonable in the absence of effects on cardiac function.

Blood Cyst of the Mitral Valve Diagnosed in an Adult after Systemic Thrombolysis

Blood cysts in valves are very rare entities in adults, which can be distinguished through their echocardiographic features. A 57-year-old woman developed sudden dyspnea while hospitalized in the context of urinary sepsis; high-risk pulmonary embolism was diagnosed and she was prescribed systemic thrombolysis. She persisted with fever raising the suspicion of bacterial endocarditis. Transthoracic echocardiography did not report any masses, but later transesophageal imaging revealed a vegetation that was finally characterized as a blood cyst of the mitral valve based on ultrasound features. The patient evolved satisfactorily and did not require surgery.

Giant intracardiac blood cyst of the mitral valve in a pediatric patient: A case report

Intracardiac blood cysts are rare congenital malformations most commonly located in the endocardium of semilunar or atrioventricular valves. They are predominantly seen in infants, especially below 2 months of age, and disappear spontaneously in the first 6 months of life making the detection of blood cysts a rare finding in the adult population. Although most patients are asymptomatic, they may occasionally present with obstruction, valvular dysfunction, or embolism. Herein, we present a 2.5-year-old female patient, who was successfully treated with surgical excision of an intracardiac blood cyst causing mild-to-moderate mitral regurgitation and obstruction.

Tricuspid regurgitation due to blood cyst

Cardiac blood cysts are confirmed by autopsies in stillbirths but rarely detected in adults. Although cardiac blood cysts are common in newborns, they disappear within a few months after birth. These cysts are blood-filled diverticula surrounded by endothelium. Their possible etiology is invaginations of atrial endothelium into the stroma of atrioventricular valves. Most blood cysts originate from the left side of the heart and are located on the atrioventricular valves. Complication is followed in very little cases, such as embolic stroke, valvular dysfunction, and ventricular outflow system obstruction. The blood cysts leading to complications should be removed surgically.

Mitral valve blood cyst occlusion of the aortic valve leading to syncope: detection by transthoracic and contrast echocardiography

Blood cysts of the mitral valve are rare in adults. These blood cysts are often asymptomatic. Blood cysts resulting in severe left ventricular outflow tract obstruction leading to syncope have not been previously report. We report an adult who developed frequent syncope due to mitral valve blood cysts occluding the aortic orifice. This condition was detected by transthoracic and contrast echocardiography. The blood cysts were successfully removed. A pathological examination confirmed the diagnosis of blood cysts. Contrast echocardiography is a useful diagnostic modality for assessing cardiac blood cysts. This technique can play the same role as magnetic resonance imaging (MRI) in hospitals without MRI or in cases where MRI is not acceptable in an emergency.

An unusual mass of tricuspid valve in an adult patient: blood-filled cyst

Blood-filled cysts (BFC) within the heart are common findings at postmortem examinations of fetuses and infants. However, such cysts are very rare entities in adolescents and adults. We report here an adult case of BFC attached to the posterior leaflet of the tricuspid valve, demonstrating the importance of multimodal diagnostic imaging combining both echocardiography and magnetic resonance imaging.

Blood cyst of subvalvular apparatus of the mitral valve in an adult

Blood cysts of the heart are rare benign tumors, usually involving the cardiac valves. They are found mainly in the first month of life and in children; and are rarely seen in adults. Here, we report a case of a blood cyst on the subvalvular apparatus of the mitral valve, which was incidentally discovered during chest computed tomography in a 47-year-old man. To the best of our knowledge, this is the first reported case of blood cyst of the heart in an adult in Korea.