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Rankovic-Nicic L, Dragicevic-Antonic M, Antonic Z, Mihajlovic V, Petrovic M, Ivosevic T, Stamenkovic G, Pelemis S, Bojic M. An Unusual Case of Cardiac Mass: A Multimodal Approach in Diagnosis and Treatment. Healthcare (Basel) 2024; 12:1009. [PMID: 38786423 PMCID: PMC11120765 DOI: 10.3390/healthcare12101009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass' blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment.
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Affiliation(s)
| | | | - Zelimir Antonic
- Institute for Cardiovascular Diseases “Dedinje”, 11040 Belgrade, Serbia
| | | | - Masa Petrovic
- Institute for Cardiovascular Diseases “Dedinje”, 11040 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tjasa Ivosevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | | | - Milovan Bojic
- Institute for Cardiovascular Diseases “Dedinje”, 11040 Belgrade, Serbia
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Cronin M, Lowery A, Kerin M, Wijns W, Soliman O. Risk Prediction, Diagnosis and Management of a Breast Cancer Patient with Treatment-Related Cardiovascular Toxicity: An Essential Overview. Cancers (Basel) 2024; 16:1845. [PMID: 38791923 PMCID: PMC11120055 DOI: 10.3390/cancers16101845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Breast cancer is amongst the most common invasive cancers in adults. There are established relationships between anti-cancer treatments for breast cancer and cardiovascular side effects. In recent years, novel anti-cancer treatments have been established, as well as the availability of multi-modal cardiac imaging and the sophistication of treatment for cardiac disease. This review provides an in-depth overview regarding the interface of breast cancer and cancer therapy-related cardiovascular toxicity. Specifically, it reviews the pathophysiology of breast cancer, the method of action in therapy-related cardiovascular toxicity from anti-cancer treatment, the use of echocardiography, cardiac CT, MRI, or nuclear medicine as diagnostics, and the current evidence-based treatments available. It is intended to be an all-encompassing review for clinicians caring for patients in this situation.
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Affiliation(s)
- Michael Cronin
- School of Medicine, University of Galway, H91 V4AY Galway, Ireland
| | - Aoife Lowery
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- CURAM Centre for Medical Devices, H91 TK33 Galway, Ireland
| | - Michael Kerin
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 V4AY Galway, Ireland
| | - William Wijns
- School of Medicine, University of Galway, H91 V4AY Galway, Ireland
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- CURAM Centre for Medical Devices, H91 TK33 Galway, Ireland
| | - Osama Soliman
- School of Medicine, University of Galway, H91 V4AY Galway, Ireland
- Precision Cardio-Oncology Research Enterprise (P-CORE), H91 TK33 Galway, Ireland
- CURAM Centre for Medical Devices, H91 TK33 Galway, Ireland
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 V4AY Galway, Ireland
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3
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Saad EA, Mukherjee T, Gandour G, Fatayerji N, Rammal A, Samuel P, Abdallah N, Ashok T. Cardiac myxomas: causes, presentations, diagnosis, and management. Ir J Med Sci 2024; 193:677-688. [PMID: 37737916 DOI: 10.1007/s11845-023-03531-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5-1 case per million individuals. This review article includes discussions based on existing literature on the role of interleukin interactions in the pathophysiology of cardiac myxoma which can lead to embolic complications, aneurysms, and CNS involvement. The objective of this narrative review was to study the variable clinical presentations of cardiac myxoma, its detection and diagnosis involving multiple modalities like genetic and hematological testing, echocardiography, CT, and MRI, of which transoesophageal echocardiogram shows excellent precision with a 90% to 96% accuracy in diagnosing CM. Individuals with the Carney complex are prone to such neoplasia. Cardiac myxomas are challenging to diagnose due to the ambiguity of their differential with thrombi. Myxomas can also be diagnosed by tumor markers like interleukin-6 and endothelial growth factors. The management of CM includes surgical excision like median sternotomy and robotic minimally invasive surgery. The use of robotic surgery in CM increased from 1.8% in 2012 to 15.1% in 2018. Tumor recurrences are uncommon but can occur due to inadequate surgical resection.
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Affiliation(s)
- Elio Assaad Saad
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Tishya Mukherjee
- Faculty of Medicine, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Moldova
| | - Georges Gandour
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Nora Fatayerji
- Faculty of Medicine and Medical Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Aya Rammal
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Peter Samuel
- International Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia.
| | - Nicolas Abdallah
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
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Elsaid A, Egdell R, Singh V, Russell S. Interesting case of regional left ventricular hypertrophy. BMJ Case Rep 2024; 17:e257882. [PMID: 38490700 PMCID: PMC10946368 DOI: 10.1136/bcr-2023-257882] [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: 03/17/2024] Open
Abstract
This is an account of an interesting case with an unusual cardiac presentation. He is a man in his 60s who presented with chest tightness to the accident and emergency unit. The initial thoughts were of acute coronary syndrome or acute aortic syndrome. The initial set of investigations was non-conclusive. His echocardiogram which was done during hospital admission showed asymmetric hypertrophy of the heart muscle. It was prudent to assess that new finding with an MRI scan. The patient presented to the hospital twice during the investigation and was treated for a lower respiratory tract infection. The MRI report showed an interventricular mass lesion extending to the right ventricular free wall with angiosarcoma being high up in the differential diagnosis. Going through the heart team discussion, the decision was to go for a transcatheter biopsy. The biopsy showed B-cell lymphoma. The treatment started and interestingly with satisfactory results.
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Affiliation(s)
- Ahmad Elsaid
- Cardiology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Robin Egdell
- East Cheshire NHS Trust, Macclesfield, Cheshire East, UK
| | - Vikram Singh
- East Cheshire NHS Trust, Macclesfield, Cheshire East, UK
| | - Stuart Russell
- East Cheshire NHS Trust, Macclesfield, Cheshire East, UK
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Badge M, Kapoor PM, Thiruselvan T, Francis J. Delineating thrombus versus myxoma: Perioperative 3D transesophageal echocardiography to the rescue! J Clin Imaging Sci 2024; 14:6. [PMID: 38469175 PMCID: PMC10927041 DOI: 10.25259/jcis_136_2023] [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: 12/29/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
Cardiac masses are a significant cause of patient morbidity and mortality by virtue of their symptoms and surgical removal. Preoperative diagnosis of a cardiac mass is usually based on clinical correlation and transthoracic echocardiography findings. Myxomas are the most common benign cardiac tumors, commonly occurring in the left atrium attached to the interatrial septum near the fossa ovalis. Although, at times atypical location and unusual morphology may pose a diagnostic dilemma with 2D echocardiography. 3D echocardiography with its multifaceted advantages, including multiplanar cropping abilities and superior imaging quality can help distinguish between a clot and a myxoma.
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Affiliation(s)
- Mohanish Badge
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - T. Thiruselvan
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Jijo Francis
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Wang Q, Wang B, Zhang X, Zhong X, Chang S, Yang J, Liang J, You Q, Zhou H, Zhang J. The usefulness of contrast echocardiography in the evaluation of cardiac masses: a multicenter study. BMC Cardiovasc Disord 2024; 24:43. [PMID: 38218809 PMCID: PMC10787966 DOI: 10.1186/s12872-024-03708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Cardiac masses can encompass a variety of conditions, such as tumors, thrombi, vegetations, calcific lesions, and other rare diseases. Treatment and management of these types of cardiac masses differ considerably. Thus, accurately distinguishing among thrombi, benign tumors, and malignant tumors in the heart is of great importance. Contrast echocardiography (CE) has emerged as a promising technology. Although published guidelines suggest that CE can enhance image quality and assist in differentiating between benign and malignant lesions, most studies on CE diagnosis of cardiac masses are limited to case reports or retrospective/small-sample-sized prospective cohorts. This study aims to evaluate the diagnostic accuracy of CE in patients with suspected cardiac masses and address the insufficient evidence for differential diagnosis using CE. METHODS Between April 2018 and July 2022, a prospective multicenter study was conducted, which included 145 consecutive patients suspected to have cardiac masses based on transthoracic echocardiography. All patients underwent CE examinations. The echocardiographic diagnosis relied on qualitative factors such as echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility as well as quantitative factors such as the area of the masses and the peak intensity ratio of the masses to adjacent myocardium (A1/A2). RESULTS The final confirmed diagnoses were as follows: 2 patients had no cardiac mass, 4 patients had pseudomass, 43 patients had thrombus, 66 patients had benign tumors, and 30 patients had malignant tumors. The receiver operating characteristic (ROC) analysis indicated that an optimal A1/A2 cutoff value of 0.499 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.977, 97.9%, 90.7%, 95.9%, and 95.1%, respectively. The optimal A1/A2 cutoff value of 1.583 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.950, 93.3%, 93.9%, 87.5%, and 96.9%, respectively. CONCLUSIONS Combined with qualitative and quantitative analyses, CE has the potential to accurately differentiate among different types of cardiac masses.
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Affiliation(s)
- Qingtao Wang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Bing Wang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Xiaofeng Zhang
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Xin Zhong
- Department of Ultrasound, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410002, China
| | - Shuai Chang
- Department of Ultrasound, First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Jinbo Yang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Jian Liang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Qiangqiang You
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Heng Zhou
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China.
| | - Jiaqi Zhang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China.
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Wang H, Yan WH, Sun JJ, Dong M, Zhang N, Liu T, Song NP, Zhong L. An extranodal Richter's syndrome presenting with cardiac diffuse large B-cell lymphoma: a case report. BMC Cardiovasc Disord 2023; 23:624. [PMID: 38129785 PMCID: PMC10740268 DOI: 10.1186/s12872-023-03663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Richter's syndrome (RS) defines the transformation of chronic lymphocytic leukemia into high-grade lymphoma, which usually involves lymph nodes and bone marrow. Extranodal involvement of the heart is an extremely rare condition. Patients with heart involvement tended to have a low response to chemotherapy and relative poor prognosis. The transformation process of RS is often insidious and nonspecific making it challenging to diagnose. CASE PRESENTATION A 64-year-old woman wih a history of chronic lymphocytic leukemia (CLL) presented with intermittent chest pain and was diagnosed with non-ST-elevation myocardial infarction (NSTEMI). However, the contrast enhanced echocardiography revealed a large irregular mass, measuring about 75.4 mm × 37.5 mm, located on the lateral and posterior wall of the right ventricle. Biopsy of the cardiac mass and the results revealed diffuse large B-cell lymphoma. CONCLUSIONS We present a case of a 64-year-old woman with aggressive diffuse large B-cell lymphoma involving the heart. This case could provide some insights in the diagnosis of cardiac lymphoma.
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MESH Headings
- Female
- Humans
- Middle Aged
- Biopsy
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Heart Neoplasms/diagnosis
- Heart Neoplasms/pathology
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Affiliation(s)
- Hua Wang
- Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao Medical College, Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, China
| | - Wei-Hong Yan
- Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao Medical College, Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, China
| | - Jun-Jie Sun
- Department of Ultrasound, Yantai Yuhuangding Hospital, Qingdao Medical College, Qingdao University, Yantai, China
| | - Mei Dong
- Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao Medical College, Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, China
| | - Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Nian-Peng Song
- Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao Medical College, Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, China
| | - Lin Zhong
- Department of Cardiology, Yantai Yuhuangding Hospital, Qingdao Medical College, Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, China.
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Capdeville S, Gholson BA, Lindner JR. Contrast Echocardiography for Assessing Myocardial Perfusion. Curr Cardiol Rep 2023; 25:1581-1587. [PMID: 37787859 DOI: 10.1007/s11886-023-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW Improvements in ultrasound methods for detecting microbubble ultrasound enhancing agents have led to an increase in the use of perfusion imaging with myocardial contrast echocardiography (MCE). This technique is now beginning to play an important role in specific clinical scenarios, which is the focus of this review. RECENT FINDINGS MCE was originally conceived as a technique for detecting resting perfusion abnormalities related to ischemia at rest or during stress from coronary artery disease. More recently, MCE has increasingly been used in circumstances where the technique's ability to provide rapid, quantitative, or bedside assessment of perfusion is advantageous. Quantitative MCE is also increasingly being used as a research technique for evaluating pathobiology and therapy that involve changes in the myocardial microcirculation. While MCE was developed and validated decades ago, it is only now beginning to be used by an increasing number of clinicians due to improvements in imaging technology and recognition of specific situations where the technique is impactful.
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Affiliation(s)
- Sofia Capdeville
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, 415 Lane Rd, Box 801394, Charlottesville, VA, 22903, USA
| | - Bethany A Gholson
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, 415 Lane Rd, Box 801394, Charlottesville, VA, 22903, USA
| | - Jonathan R Lindner
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Center, University of Virginia, 415 Lane Rd, Box 801394, Charlottesville, VA, 22903, USA.
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Aboukhoudir F, Veyrier J, Dernys A, Moussa K, Pankert M, Rekik S, Habib G. [Extensive cardiac thombosis in a patient with disseminated intravascular coagulation]. Ann Cardiol Angeiol (Paris) 2023; 72:101643. [PMID: 37660409 DOI: 10.1016/j.ancard.2023.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023]
Abstract
Disseminated intravascular coagulation is a syndrome characterized by thrombin and fibrin generation which is associated with organ failure and death. Intracardiac thrombus may occur and further deteriorate prognosis. We report the case of a patient with massive intraventricular thrombus revealed by an acute ischemia of the upper left limb in a context of pulmonary adenocarcinoma complicated by a disseminated intravascular coagulation. We describe the diagnostic modalities and the fatal evolution.
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Affiliation(s)
- Falah Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France; EA4278, laboratoire de pharm-écologie-cardiovasculaire, Avignon université, Avignon, France.
| | - Jason Veyrier
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
| | - Alexandra Dernys
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
| | - Karim Moussa
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
| | - Mathieu Pankert
- Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
| | - Sofiene Rekik
- Service de cardiologie, centre hospitalier Nord Franche comté, France.
| | - Gilbert Habib
- Aix-Marseille Université, URMITE, Marseille, France ; APHM, Hôpital La Timone, Service de Cardiologie, Marseille, France
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Dow S, Conroy T, Teveris V, Waltman J, Rassias A, Liu X, Taub C. Fleshing Out the Invisible: A Pericardial Paraganglioma. CASE (PHILADELPHIA, PA.) 2023; 7:438-444. [PMID: 38028386 PMCID: PMC10679540 DOI: 10.1016/j.case.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
•Pericardial paragangliomas can present with angina and dyspnea. •TTE is often the first-line test for assessing pericardial tumors. •Long sweeps and contrast enhancement may enhance visualization of pericardial masses. •Multimodality imaging may help differentiate malignant from benign tumors.
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Affiliation(s)
- Sam Dow
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Taylor Conroy
- Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Victoria Teveris
- Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jonathan Waltman
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Athos Rassias
- Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Xiaoying Liu
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Cynthia Taub
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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11
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Chen X, Chen Y, Xiao F, Liu M, Gu Z, Li Y, Hong M. Survival and analysis of prognostic factors for primary malignant cardiac tumors based on the SEER database. J Cancer Res Clin Oncol 2023; 149:15687-15696. [PMID: 37665405 DOI: 10.1007/s00432-023-05351-4] [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: 07/27/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The purpose of this study was to use the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the survival rate of primary malignant cardiac tumors (PMCTs), assess the risk factors affecting survival, and calculate the number of PMCT cases in recent years. METHODS SEER 22 registries were used to calculate the number of cases PMCT. Data on age, sex, race, marital status, tumor size, the American Joint Committee on Cancer (AJCC) stage, lymph node involvement, metastasis, treatment, and survival were collected to analyze the survival and prognostic factors of SEER 17 registries. Using the Kaplan-Meier estimation method, a survival curve was obtained according to the influencing factors, and a multivariable Cox regression model was established. RESULTS In recent years, the average annual number of PMCT cases was 20.56 ± 7.12, significantly higher than the average before 2004 (P = 0.015; 95% CI 1.14-8.98). The 1-, 3-, and 5-year survival rates were 45.6%, 18.8%, and 11.2%, respectively. Multivariate analysis revealed that age (risk ratio [HR], 2.047; 95% CI 1.381-3.034), AJCC stage III (HR, 1.786; 95% CI 1.123-2.839), AJCC staging with distant metastasis (HR, 2.666; 95% CI 1.509-4.709), no chemotherapy (HR, 2.011; 95% CI 1.561-2.590), and tumor size larger than 99 mm (HR, 1.766; 95% CI 1.132-2.756) were independent risk factors for poor prognosis. Only age over 76 years and distant metastasis were independent risk factors for prognosis in the chemotherapy group. CONCLUSION In recent years, the annual number of patients with PMCT has increased significantly. Due to developments in chemotherapy, we should re-evaluate the traditional tumor staging and prognostic risk indicators to improve clinical applications.
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Affiliation(s)
- Xiaoxiao Chen
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Yizhou Chen
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Fangping Xiao
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Meng Liu
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Zhan Gu
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Yi Li
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China
| | - Mei Hong
- The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, China.
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12
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Maidman SD, Bamira D, Vainrib AF, Ro R, Saric M. Cysts Around the Heart: Differential Diagnosis and Multimodality Imaging Strategies for Paracardiac Cysts. CASE (PHILADELPHIA, PA.) 2023; 7:365-376. [PMID: 37791128 PMCID: PMC10543172 DOI: 10.1016/j.case.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
•Paracardiac cysts (located adjacent to or inside the heart) are rarely detected. •There is a broad differential diagnosis for cysts encountered with echocardiography. •Multimodality imaging is crucial for comprehensively evaluating paracardiac cysts.
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Affiliation(s)
- Samuel D. Maidman
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Alan F. Vainrib
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Richard Ro
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
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13
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Yue P, Xu Z, Wan K, Tan Y, Xu Y, Xie X, Mui D, Yi C, Han Y, Chen Y. Multiparametric mapping by cardiovascular magnetic resonance imaging in cardiac tumors. J Cardiovasc Magn Reson 2023; 25:37. [PMID: 37349765 PMCID: PMC10286406 DOI: 10.1186/s12968-023-00938-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/11/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND There is a paucity of quantitative measurements of cardiac tumors and myocardium using parametric mapping techniques. This study aims to explore quantitative characteristics and diagnostic performance of native T1, T2, and extracellular volume (ECV) values of cardiac tumors and left ventricular (LV) myocardium. METHODS Patients with suspected cardiac tumors who underwent cardiovascular magnetic resonance (CMR) between November 2013 and March 2021 were prospectively enrolled. The diagnoses of primary benign or malignant tumors were based on pathologic findings if available, comprehensive medical history evaluations, imaging, and long-term follow-up data. Patients with pseudo-tumors, cardiac metastasis, primary cardiac diseases, and prior radiotherapy or chemotherapy were excluded. Multiparametric mapping values were measured on both cardiac tumors and the LV myocardium. Statistical analyses were performed using independent-samples t-test, receiver operating characteristic, and Bland-Altman analyses. RESULTS A total of 80 patients diagnosed with benign (n = 54), or primary malignant cardiac tumors (n = 26), and 50 age and sex-matched healthy volunteers were included. Intergroup differences in the T1 and T2 values of cardiac tumors were not significant, however, patients with primary malignant cardiac tumors showed significantly higher mean myocardial T1 values (1360 ± 61.4 ms) compared with patients with benign tumors (1259.7 ± 46.2 ms), and normal controls (1206 ± 44.0 ms, all P < 0.05) at 3 T. Patients with primary malignant cardiac tumors also showed significantly higher mean ECV (34.6 ± 5.2%) compared with patients with benign (30.0 ± 2.5%) tumors, and normal controls (27.3 ± 3.0%, all P < 0.05). For the differentiation between primary malignant and benign cardiac tumors, the mean myocardial native T1 value showed the highest efficacy (AUC: 0.919, cutoff value: 1300 ms) compared with mean ECV (AUC: 0.817) and T2 (AUC: 0.619) values. CONCLUSION Native T1 and T2 of cardiac tumors showed high heterogeneity, while myocardial native T1 values in primary malignant cardiac tumors were elevated compared to patients with benign cardiac tumors, which may serve as a new imaging marker for primary malignant cardiac tumors.
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Affiliation(s)
- Pengfei Yue
- Division of Abdominal Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Ziqian Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yinxi Tan
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Xiaotong Xie
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - David Mui
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Cheng Yi
- Division of Abdominal Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yuchi Han
- Cardiovascular Division, Wexner Medical Center, The Ohio State University, Columbus, OH USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
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14
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Morin CE, Griffin LM, Beroukhim RS, Caro-Domínguez P, Chan S, Johnson JN, Infante JC, Lam CZ, Malone LJ, Tang ER, Taylor MD, Wilkinson JC, Masand PM. Imaging of pediatric cardiac tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29955. [PMID: 36083866 PMCID: PMC10641876 DOI: 10.1002/pbc.29955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
Cardiac tumors in children are rare and the majority are benign. The most common cardiac tumor in children is rhabdomyoma, usually associated with tuberous sclerosis complex. Other benign cardiac masses include fibromas, myxomas, hemangiomas, and teratomas. Primary malignant cardiac tumors are exceedingly rare, with the most common pathology being soft tissue sarcomas. This paper provides consensus-based imaging recommendations for the evaluation of patients with cardiac tumors at diagnosis and follow-up, including during and after therapy.
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Affiliation(s)
- Cara E. Morin
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | | | - Pablo Caro-Domínguez
- Pediatric Radiology Unit, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Sherwin Chan
- Department of Radiology, Children’s Mercy Kansas City, Kansas City, MO; Department of Radiology, University of Missouri at Kansas City School of Medicine, Kansas City, MO
| | - Jason N. Johnson
- Department of Pediatrics and Radiology, The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN
| | - Juan C. Infante
- Department of Radiology, Nemours Children’s Hospital, Orlando, FL
| | - Christopher Z. Lam
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - LaDonna J. Malone
- Department of Radiology, University of Colorado, Children’s Hospital of Colorado, Aurora, CO
| | - Elizabeth R. Tang
- Radiology Department, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Michael D. Taylor
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - James C. Wilkinson
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | - Prakash M. Masand
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital
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15
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Ro SK, Sato K, Ijuin S, Sela D, Fior G, Heinsar S, Kim JY, Chan J, Nonaka H, Lin ACW, Bassi GL, Platts DG, Obonyo NG, Suen JY, Fraser JF. Assessment and diagnosis of right ventricular failure-retrospection and future directions. Front Cardiovasc Med 2023; 10:1030864. [PMID: 37324632 PMCID: PMC10268009 DOI: 10.3389/fcvm.2023.1030864] [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] [Received: 08/29/2022] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
The right ventricle (RV) has a critical role in hemodynamics and right ventricular failure (RVF) often leads to poor clinical outcome. Despite the clinical importance of RVF, its definition and recognition currently rely on patients' symptoms and signs, rather than on objective parameters from quantifying RV dimensions and function. A key challenge is the geometrical complexity of the RV, which often makes it difficult to assess RV function accurately. There are several assessment modalities currently utilized in the clinical settings. Each diagnostic investigation has both advantages and limitations according to its characteristics. The purpose of this review is to reflect on the current diagnostic tools, consider the potential technological advancements and propose how to improve the assessment of right ventricular failure. Advanced technique such as automatic evaluation with artificial intelligence and 3-dimensional assessment for the complex RV structure has a potential to improve RV assessment by increasing accuracy and reproducibility of the measurements. Further, noninvasive assessments for RV-pulmonary artery coupling and right and left ventricular interaction are also warranted to overcome the load-related limitations for the accurate evaluation of RV contractile function. Future studies to cross-validate the advanced technologies in various populations are required.
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Affiliation(s)
- Sun Kyun Ro
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Shinichi Ijuin
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Declan Sela
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Gabriele Fior
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, QLD, Australia
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jonathan Chan
- Division of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Hideaki Nonaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Aaron C. W. Lin
- Division of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - David G. Platts
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Division of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Nchafatso G. Obonyo
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
- Initiative to Develop African Research Leaders (IDeAL)/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Jacky Y. Suen
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, QLD, Australia
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16
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QUAH KHK, FOO JS, KOH CH. Approach to Cardiac Masses Using Multimodal Cardiac Imaging. Curr Probl Cardiol 2023; 48:101731. [PMID: 37030421 DOI: 10.1016/j.cpcardiol.2023.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
Incidental cardiac masses can pose diagnostic challenges given the numerous differentials, and difficulty in obtaining tissue confirmation without invasive procedures. With recent advancements in cardiac imaging technology, non-invasive efforts to diagnose the intracardiac lesions have become more surmountable. In this paper, we report a case of a patient incidentally found to have an intra-cardiac mass during routine evaluation. Transthoracic echocardiography demonstrated a small mass attached to the tricuspid valve, which was not visualized on follow up cardiac magnetic resonance imaging. Here, we review the currently available cardiac imaging modalities and discuss their values and limitations. From this, we also propose a workflow in the approach to utilizing different imaging modalities to reach a conclusive diagnosis of undifferentiated cardiac masses.
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17
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Kesieme EB, Buchan KG. Multiple Right Ventricular Haemangiomas. Cureus 2023; 15:e36570. [PMID: 37095811 PMCID: PMC10122193 DOI: 10.7759/cureus.36570] [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] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Right ventricular haemangiomas are rare benign tumours, usually solitary and commonly located in the right heart. We report a 49-year-old female who presented with four masses in the right ventricle, three arising from the right ventricular free wall and one arising from the anterior leaflet of the tricuspid valve. She subsequently underwent total excision of the tumours and an anteroinferior commissuroplasty for severe tricuspid regurgitation complicating the excision. Histology confirmed cavernous haemangioma. Solitary haemangioma of the right ventricle has been reported severally in the literature but, to the best of our knowledge, this is the first report of multiple right ventricular haemangiomas.
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Affiliation(s)
- Emeka B Kesieme
- Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, GBR
| | - Keith G Buchan
- Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, GBR
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18
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Fioretti AM, Leopizzi T, La Forgia D, Scicchitano P, Oreste D, Fanizzi A, Massafra R, Oliva S. Incidental right atrial mass in a patient with secondary pancreatic cancer: A case report and review of literature. World J Clin Cases 2023; 11:1206-1216. [PMID: 36874413 PMCID: PMC9979295 DOI: 10.12998/wjcc.v11.i5.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/30/2022] [Accepted: 01/10/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND The incidental detection of a right atrial mass during routine cardioncological workup is a rare condition. The correct differential diagnosis between cancer and thrombi is challenging. A biopsy may not be feasible while diagnostic techniques and tools may not be available.
CASE SUMMARY We report the case of a 59-year-old female patient with a history of breast cancer and current secondary metastatic pancreatic cancer. She developed deep vein thrombosis and pulmonary embolism and was admitted to the Outpatient Clinic of our Cardio-Oncology Unit for follow-up. Transthoracic echocardiogram incidentally found a right atrial mass. Clinical management was difficult due to the abrupt worsening of the patient’s clinical condition and the progressive severe thrombocytopenia. We suspected a thrombus, according to its echocardiographic appearance, the patient’s cancer history and recent venous thromboembolism. The patient was unable to adhere to low molecular weight heparin treatment. Due to worsening prognosis, palliative care was recommended. We also highlighted the distinguishing features between thrombi and tumors. We proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.
CONCLUSION This case report highlights the importance of cardioncological surveillance during anticancer treatments to detect cardiac masses.
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Affiliation(s)
| | - Tiziana Leopizzi
- Cardiology and Intensive Care Unit, Ospedale SS. Annunziata, Taranto 74121, Italy
| | - Daniele La Forgia
- Department of Radiology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Pietro Scicchitano
- Cardiology and Intensive Care Unit, Ospedale “Fabio Perinei”, Altamura (Bari) 70022, Italy
| | - Donato Oreste
- Department of Radiology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Annarita Fanizzi
- Department of Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Raffaella Massafra
- Department of Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Stefano Oliva
- Cardio-Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
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19
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Berdica L, Kola E, Nakuci D, Horjeti E, Alimehmeti M. Cardiac hemangioma presenting as a primary cardiac tumor. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:3. [PMID: 36647178 PMCID: PMC9843832 DOI: 10.1186/s40959-023-00154-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
Cardiac hemangiomas are very rare benign cardiac tumors. They can present at any age and clinical presentation varies according to location and size. We encountered an 87-year-old woman with a left atrial hemangioma clinically diagnosed as cardiac myxoma. Histopathological examination revealed that it was a cavernous-type hemangioma Left atrial hemangiomas, especially those attached to the left atrium wall, may be mistakenly diagnosed as myxomas. Furthermore, a comprehensive review of atrial hemangioma was conducted for the diagnosis and treatment of this uncommon entity.
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Affiliation(s)
- Leart Berdica
- Department of Pathology, Mother Teresa University Hospital Center, Tirana, Albania
| | - Erisa Kola
- Department of Pathology, Gjirokaster Hsopital, Gjirokaster, Albania
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20
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 684] [Impact Index Per Article: 342.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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21
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Peng J, Sun PT, Cen H, Liu YX, Zhu W, Ran PC. Incremental value of combinatorial contrast echocardiography and 18F-fluorodeoxyglucose positron emission tomography/computed tomography in giant right atrial myxomas. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1268-1270. [PMID: 36215199 DOI: 10.1002/jcu.23360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Although several studies have shown that myocardial contrast echocardiography and 18-FDG PET/CT can differentiate between benign and malignant intracardiac masses, it is rarely used in practice to evaluate myxoma. This case describes the contrast echocardiography and 18-FDG PET/CT findings of a giant myxoma with an atypical location and subclinical symptoms.
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Affiliation(s)
- Jie Peng
- Department of Ultrasound, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Peng-Tao Sun
- Department of Ultrasound, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Huan Cen
- Department of Ultrasound, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yue-Xia Liu
- Department of Ultrasound, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wei Zhu
- Department of Cardiac surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Peng-Cheng Ran
- Department of Nuclear medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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22
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Multimodality Imaging of Benign Primary Cardiac Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102543. [PMID: 36292232 PMCID: PMC9601182 DOI: 10.3390/diagnostics12102543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.
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23
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Baldassarre LA, Ganatra S, Lopez-Mattei J, Yang EH, Zaha VG, Wong TC, Ayoub C, DeCara JM, Dent S, Deswal A, Ghosh AK, Henry M, Khemka A, Leja M, Rudski L, Villarraga HR, Liu JE, Barac A, Scherrer-Crosbie M. Advances in Multimodality Imaging in Cardio-Oncology: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:1560-1578. [PMID: 36229093 DOI: 10.1016/j.jacc.2022.08.743] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022]
Abstract
The population of patients with cancer is rapidly expanding, and the diagnosis and monitoring of cardiovascular complications greatly rely on imaging. Numerous advances in the field of cardio-oncology and imaging have occurred in recent years. This review presents updated and practical approaches for multimodality cardiovascular imaging in the cardio-oncology patient and provides recommendations for imaging to detect the myriad of adverse cardiovascular effects associated with antineoplastic therapy, such as cardiomyopathy, atherosclerosis, vascular toxicity, myocarditis, valve disease, and cardiac masses. Uniquely, we address the role of cardiovascular imaging in patients with pre-existing cardiomyopathy, pregnant patients, long-term survivors, and populations with limited resources. We also address future avenues of investigation and opportunities for artificial intelligence applications in cardio-oncology imaging. This review provides a uniform practical approach to cardiovascular imaging for patients with cancer.
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Affiliation(s)
- Lauren A Baldassarre
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarju Ganatra
- Cardio-Oncology and Cardiac MRI Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Juan Lopez-Mattei
- Cardiovascular Imaging Program, Department of Cardiovascular Medicine, Lee Health, Fort Myers, Florida, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Vlad G Zaha
- Cardio-Oncology Program, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Timothy C Wong
- UPMC Cardiovascular Magnetic Resonance Center, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chadi Ayoub
- Division of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeanne M DeCara
- Cardio-Oncology Program, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Cardio-Oncology Service, University College London Hospital and Hatter Cardiovascular Institute, London, United Kingdom
| | - Mariana Henry
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Abhishek Khemka
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Monika Leja
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lawrence Rudski
- Azrieli Heart Center, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jennifer E Liu
- Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ana Barac
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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24
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Cotter B, Raisinghani A, DeMaria AN. Established and emerging roles for ultrasound enhancing agents (contrast echocardiography). Clin Cardiol 2022; 45:1114-1122. [PMID: 36183366 DOI: 10.1002/clc.23924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
The ability to opacify the left ventricle and delineate the endocardium after intravenous injection of microbubble ultrasound enhancing agents is of established value to quantify volumes and function in suboptimal unenhanced images, particularly in stress echocardiograms. However, applications other than quantitation of left ventricle structure and function exist for contrast enhanced left ventricular opacification. Contrast agents enable recording of Doppler velocity signals in patients with poor ultrasound transmission, providing estimates of aortic stenosis gradient and pulmonary artery pressures. Contrast echo is of value in detecting apical hypertrophic cardiomyopathy and accompanying apical aneurysms. Most importantly, ultrasound enhancing agents can identify apical and left atrial masses when they cannot be visualized in unenhanced images, and can distinguish thrombi from tumors by visualizing the vascularity inherent in tumors. Contrast agents distinguish trabecular from compacted myocardium in noncompaction syndrome, and hypertrabeculation with other abnormal conditions. A major potential application of ultrasound enhancing agents is myocardial opacification, which can assist in identifying nonviable myocardium. Also, the delayed reappearance of myocardial perfusion after microbubble destruction identifies impaired contrary flow and can diagnose coronary stenosis. Innovative applications of ultrasound contrast agents currently under investigation, include visualizing the vaso vasorum to identify plaques and assess their vulnerability, and theranostic agents to deliver drugs and biologists and to assist in sonothrombolysis. It is anticipated that the role of ultrasound contrast agents will continue to increase in the future.
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Affiliation(s)
- Bruno Cotter
- Division of Cardiology, Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Ajit Raisinghani
- Division of Cardiology, Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
| | - Anthony N DeMaria
- Division of Cardiology, Department of Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California, USA
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Pino PG, Moreo A, Lestuzzi C. Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1177-1193. [PMID: 36218203 PMCID: PMC9828386 DOI: 10.1002/jcu.23309] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cardiac tumors may be primary (either benign or malignant) or secondary (malignant) and are first detected by echocardiography in most cases. The cardiologist often challenges their identification, the differential diagnosis and the best therapeutic approach. Malignant tumors have usually a poor prognosis, which may be significantly improved by appropriate and timely therapies. The echocardiographic aspects of benign and malignant cardiac tumors described in this article, along with a clinical evaluation may orient the differential diagnosis and aid in choosing the further steps useful to define the nature of the mass.
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Affiliation(s)
- Paolo G. Pino
- Former Chief of Non Invasive Cardiovascular Diagnostics DepartmentOspedale San CamilloRomeItaly
| | - Antonella Moreo
- Cardiology IV, 'A.De Gasperis'DepartmentNiguarda Ca' Granda HospitalMilanItaly
| | - Chiara Lestuzzi
- Cardio‐oncological Rehabilitation Service, Azienda Sanitaria Friuli Occidentale (ASFO)c/o National Cancer Institute (CRO), IRCCSAvianoItaly
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26
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Yamat M, Wali E, Lee L, Henry M, Ward RP, Paul J, Lang RM. Multiple Intracardiac Masses Involving 3 Chambers of the Heart. CASE (PHILADELPHIA, PA.) 2022; 6:467-470. [PMID: 36589340 PMCID: PMC9794497 DOI: 10.1016/j.case.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 42-year-old man presented with multiple cardiac masses. Metastatic disease is far more prevalent than primary cardiac tumors. Multimodality imaging aids in the diagnostic and management strategy. Optimal treatment of large, chronic intracardiac thrombi needs to be refined.
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Affiliation(s)
- Megan Yamat
- Correspondence: Megan Yamat, ACS, RDCS, RCS, FASE, University of Chicago Medicine, 5758 South Maryland Avenue, DCAM 5613, Chicago, IL 60637
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Li Y, Ren W, Wang X, Xiao Y, Feng Y, Shi P, Sun L, Wang X, Yang H, Song G. The diagnostic accuracy of contrast echocardiography in patients with suspected cardiac masses: A preliminary multicenter, cross-sectional study. Front Cardiovasc Med 2022; 9:1011560. [PMID: 36187014 PMCID: PMC9523017 DOI: 10.3389/fcvm.2022.1011560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background To evaluate the diagnostic accuracy of contrast echocardiography (CE) in patients with suspected cardiac masses. Methods A multicenter, prospective study involving 108 consecutive patients with suspected cardiac masses based on transthoracic echocardiography performed between November 2019 and December 2020 was carried out. CE examinations were performed in all patients. The echocardiographic diagnosis was established according to the qualitative (echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility) and quantitative (area of the masses and peak intensity ratio of the masses and adjacent myocardium A1/A2) evaluations. Results Final confirmed diagnoses were as follows: no cardiac mass (n = 3), pseudomass (n = 3), thrombus (n = 36), benign tumor (n = 30), and malignant tumor (n = 36). ROC analysis revealed the optimal A1/A2 with cutoff value of 0.295 for a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.958 (95% confidence interval (CI): 0.899–0.988), 100, 91.7, 95.7, and 100%, respectively. CE was able to distinguish malignant from benign tumors with an AUC of 0.953 (95% CI: 0.870–0.990). Multivariate logistic regression analysis revealed that tumor area, base, and A1/A2 were associated with the risk of malignant tumor (OR = 1.003, 95% CI: 1.00003–1.005; OR = 22.64, 95% CI: 1.30–395.21; OR = 165.39, 95% CI: 4.68–5,850.94, respectively). When using A1/A2 > 1.28 as the only diagnostic criterion to identify the malignant tumor, AUC, sensitivity, specificity, PPV, and NPV were 0.886 (95% CI: 0.784–0.951), 80.6, 96.7, 96.7, and 80.7%, respectively. Conclusion CE has the potential to accurately differentiate cardiac masses by combining qualitative and quantitative analyses. However, more studies with a large sample size should be conducted to further confirm these findings. Clinical trial registration http://www.chictr.org.cn/, identifier: ChiCTR1900026809.
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Affiliation(s)
- Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yueqin Feng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Pengli Shi
- Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Lijuan Sun
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiao Wang
- Department of Ultrasound, Anshan Central Hospital, Anshan, China
| | - Huan Yang
- Department of Ultrasound, Yingkou Central Hospital, Yingkou, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Guang Song
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Allard L, Bernhard B, Windecker S, Valgimigli M, Gräni C. Left ventricular thrombus in ischaemic heart disease: diagnosis, treatment, and gaps of knowledge. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:496-509. [PMID: 34928322 DOI: 10.1093/ehjqcco/qcab097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022]
Abstract
Although the management of ischaemic heart disease has markedly improved over the last decades, left ventricular thrombus remains a serious finding in patients with myocardial infarction. Routine diagnostic detection of left ventricular thrombus relies mainly on echocardiography; however, cardiac magnetic resonance has emerged as a method with higher diagnostic accuracy, while cardiac computed tomography angiography represents a valuable alternative modality. To reduce the left ventricular thrombus-associated morbidity and mortality, optimal selection of anticoagulation is warranted after balancing the risk of bleeding. In this review, we will discuss contemporary diagnostic modalities to detect left ventricular thrombus in ischaemic heart disease and summarize evidence on risk stratification and therapy. In addition, we propose a novel diagnosis, follow-up imaging, and treatment algorithm. Further, we identify knowledge gaps at different levels to address emerging research questions and to refine the design of future studies aiming to improve the management of patients in this clinical setting.
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Affiliation(s)
- Ludovic Allard
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Benedikt Bernhard
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.,Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale and Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Christoph Gräni
- Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
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30
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Liu L, Fang A, Cheng S, Guo G, Zhang S, Chen X, Pan J, Sun B, Yao J. Diagnosis and survival analyses of patients with space-occupying cardiac lesions: a 10-year retrospective single-center study. Quant Imaging Med Surg 2022; 12:4081-4094. [PMID: 35919055 PMCID: PMC9338381 DOI: 10.21037/qims-21-1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/01/2022] [Indexed: 12/02/2022]
Abstract
Background Space-occupying cardiac lesions are uncommon but fatal. Echocardiography can identify diseases quickly in the clinic. This study reviews the clinical data of patients with space-occupying cardiac lesions in the past 10 years and analyzes their echocardiographic features, pathological diagnosis, and prognosis. Methods We performed a retrospective analysis of 412 patients admitted to Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing from 2011 to 2020. All patients were diagnosed with cardiac masses based on transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). We compared the diagnostic results of echocardiography and the postoperative pathological diagnosis and analyzed the characteristics of different types of space-occupying cardiac lesions. We also compared the mortality of patients with different types of space-occupying cardiac lesions through follow-up results of postoperative patients. Results The 412 patients included 189 males and 223 females. Among them, 214 patients had benign tumors (including 176 patients with myxomas), 29 had primary malignant tumors, 32 had metastatic tumors, 41 had thrombi, 92 had infectious neoplasms, and 4 patients had special types of space-occupying lesions. A total of 376 lesions were correctly characterized by TTE, with an accuracy of 91.3%. Patients with benign tumors (9/214), thrombi (4/41), infectious neoplasms (5/92), or special types of space-occupying lesions (0/4) exhibited low rates of mortality or recurrence. In contrast, patients with primary malignant tumors (16/29) or metastatic tumors (16/32) exhibited high mortality rates. Conclusions Echocardiography is a valuable tool for characterizing space-occupying cardiac lesions. It can provide important preoperative diagnostic information for cardiothoracic surgeons.
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Affiliation(s)
- Lei Liu
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Aijuan Fang
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Siyuan Cheng
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Guanjun Guo
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Suming Zhang
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaofang Chen
- Department of Cardiothoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun Pan
- Department of Cardiothoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Bugao Sun
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jing Yao
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Ezzeddine FM, Haq IU, Pessanha BS, Pislaru SV, Bois MC, Kummer T, Stanich JA. Point-of-Care Ultrasound Diagnosis of a Giant Left Atrial Mass. CASE 2022; 6:243-246. [PMID: 36036056 PMCID: PMC9399556 DOI: 10.1016/j.case.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiac myxomas can cause cardiac, embolic, and/or constitutional symptoms. POCUS augments emergency care and assists in clinical decision-making. Multimodality imaging can help discern CMs from thrombi and other tumors.
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32
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Aghayev A, Cheezum MK, Steigner ML, Mousavi N, Padera R, Barac A, Kwong RY, Di Carli MF, Blankstein R. Multimodality imaging to distinguish between benign and malignant cardiac masses. J Nucl Cardiol 2022; 29:1504-1517. [PMID: 34476778 DOI: 10.1007/s12350-021-02790-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/25/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND To compare the diagnostic accuracy of CMR and FDG-PET/CT and their complementary role to distinguish benign vs malignant cardiac masses. METHODS Retrospectively assessed patients with cardiac mass who underwent CMR and FDG-PET/CT within a month between 2003 and 2018. RESULTS 72 patients who had CMR and FDG-PET/CT were included. 25 patients (35%) were diagnosed with benign and 47 (65%) were diagnosed with malignant masses. 56 patients had histological correlation: 9 benign and 47 malignant masses. CMR and FDG-PET/CT had a high accuracy in differentiating benign vs malignant masses, with the presence of CMR features demonstrating a higher sensitivity (98%), while FDG uptake with SUVmax/blood pool ≥ 3.0 demonstrating a high specificity (88%). Combining multiple (> 4) CMR features and FDG uptake (SUVmax/blood pool ratio ≥ 3.0) yielded a sensitivity of 85% and specificity of 88% to diagnose malignant masses. Over a mean follow-up of 2.6 years (IQR 0.3-3.8 years), risk-adjusted mortality were highest among patients with an infiltrative border on CMR (adjusted HR 3.1; 95% CI 1.5-6.5; P = .002) or focal extracardiac FDG uptake (adjusted HR 3.8; 95% CI 1.9-7.7; P < .001). CONCLUSION Although CMR and FDG-PET/CT can independently diagnose benign and malignant masses, the combination of these modalities provides complementary value in select cases.
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Affiliation(s)
- Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Michael L Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Negareh Mousavi
- Cardiovascular Division, McGill University Health Center, Montreal, QC, Canada
| | - Robert Padera
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Raymond Y Kwong
- Cardiovascular Imaging Program, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Zalewska-Adamiec M, Bachorzewska-Gajewska H, Dobrzycki S. Echocardiography, Computed Tomography and Magnetic Resonance Imaging in the Differential Diagnosis of a Tumor in the Left Atrium of the Heart. Diagnostics (Basel) 2022; 12:diagnostics12071749. [PMID: 35885652 PMCID: PMC9321345 DOI: 10.3390/diagnostics12071749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiac tumors are rare. Most often they are metastatic tumors, while primary tumors are much less common. In addition to proliferative changes in the heart, there are also non-neoplastic structures, such as thrombus, vegetation or inflammatory tumors. All structures with a heart tumor morphology require a lot of imaging studies in order to diagnose them and plan treatment without performing a biopsy. We present a case of a 75-year-old female patient who had moving masses in the left atrium on echocardiography. Computed tomography of the chest was performed, which did not clearly explain the nature of the structure observed in the left atrium. The Heart Team decided to perform another test—magnetic resonance imaging (MRI) of the heart in 3 months to differentiate the lesion. The examination was performed after 3 months of warfarin therapy and there were no masses in the left atrium, which confirmed that the observed tumor was a thrombus.
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Affiliation(s)
- Malgorzata Zalewska-Adamiec
- Department of Invasive Cardiology, Medical University of Bialystok, 15-089 Bialystok, Poland; (H.B.-G.); (S.D.)
- Correspondence: ; Tel.: +488-583-184-96
| | - Hanna Bachorzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, 15-089 Bialystok, Poland; (H.B.-G.); (S.D.)
- Department of Clinical Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Slawomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, 15-089 Bialystok, Poland; (H.B.-G.); (S.D.)
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Bernstein HM, English C, Young RB, Venugopal S. A 70-Year-Old Man With Relapsed CNS Lymphoma Has Incidental Finding of Right Atrial Mass. Chest 2022; 162:e43-e48. [DOI: 10.1016/j.chest.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 12/01/2022] Open
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Yin H, Mao W, Tan H, Zhu N, Wan Q, Shi J, Qiu L, Xiu Y, Luo R, Yu H, Shi H. Role of 18F-FDG PET/CT imaging in cardiac and pericardial masses. J Nucl Cardiol 2022; 29:1293-1303. [PMID: 33462788 DOI: 10.1007/s12350-020-02510-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/21/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Considering the few reported cardiac masses, PET/CT in the imaging workup of cardiac masses is not well established. This retrospective study analyzed the role of 18F-FDG PET/CT imaging in cardiac/pericardial masses. METHODS AND RESULTS Fifty-nine patients with newly diagnosed cardiac/pericardial masses who underwent PET/CT and transthoracic echocardiography (TTE) were recruited. Echocardiographic and PET/CT characteristics were evaluated for predictive value in differentiating malignant and non-malignant lesions using histologic confirmation as the gold standard. The McNemar test was used to test the differences in sensitivity between PET/CT and TTE. 18F-FDG PET/CT had higher sensitivity in determining the malignancy of cardiac/pericardial masses compared to TTE (sensitivity, 96.6% vs 72.4%, P = .039). However, when pericardial masses were excluded from the analysis, the difference in sensitivity between the two was not statistically significant (sensitivity, 95.6% vs 78.3%, P = .219). 18F-FDG PET/CT identified two malignant pericardial masses missed on TTE, changed the diagnostic orientation of TTE in 15 patients, and found seven patients with extracardiac lesions in 29 malignant patients. CONCLUSIONS PET/CT was an effective additional image modality in patients with suspected malignant cardiac mass for further confirmation and to screen for potential metastasis.
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Affiliation(s)
- Hongyan Yin
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Wujian Mao
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Hui Tan
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Na Zhu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quan Wan
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Shi
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Qiu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Yan Xiu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haojun Yu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
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Li M, Hu W, Wang C, Wan L, Liang Y, Duan X, Zhang L, Meng H. Clinical and echocardiographic characteristics of cardiac blood cysts. J Cardiol 2022; 80:261-267. [PMID: 35589466 DOI: 10.1016/j.jjcc.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/21/2022] [Accepted: 04/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiac blood cysts (BCs) are rare benign cardiac masses. This study aimed to summarize the clinical and echocardiographic characteristics and clinical outcomes of patients with BCs. METHODS This retrospective study enrolled patients diagnosed with BC between 2009 and 2021 at a single center in China. Their clinical and echocardiographic characteristics, management, and outcomes at follow-up are summarized. RESULTS The study population comprised 26 patients with BCs with a mean age of 40 ± 19 years (median, 42 years; range, 27-56 years). The cohort was predominantly male (16, 62%). Twenty-two (81%) patients were symptomatic: dyspnea or exertional dyspnea (11, 42%) and palpitations (6, 23%) were the most frequent symptoms. Most cysts appeared as single round, oval, or lobulated anechoic masses, measuring 4-30 mm (mean, 18 mm). Half of the BCs (13, 50%) were pedunculated and mobile, and the others swung with the movement of the valve. The mitral valve (13, 50%) was the most common site of occurrence, followed by the tricuspid valve (6, 23%), right atrium (4, 15%), and aortic valve (3, 12%). Contrast echocardiography, which was performed for two patients, revealed a closed cyst without bubbles. Five cases were complicated by left ventricular outflow tract obstruction and six by valve prolapse. Eighteen patients underwent surgery, and one received antiplatelet therapy. Cardiovascular or cerebrovascular events did not occur in any patient during the follow-up period. CONCLUSION Cardiac BCs are most commonly attached to the atrioventricular valve. Echocardiography is considered to be the most useful imaging modality for assessing BC. The management of patients with BC should be individualized based on the symptoms and associated complications.
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Affiliation(s)
- Muzi Li
- Department of Echocardiography, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Echocardiography, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Wenwen Hu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Wang
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linyuan Wan
- Department of Echocardiography, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Liang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuejing Duan
- Department of Pathology, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhang
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Meng
- Department of Echocardiography, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Echocardiography, Fuwai Yunnan Cardiovascular Hospital, Kunming, China.
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Islam AKMM. Cardiac myxomas: A narrative review. World J Cardiol 2022; 14:206-219. [PMID: 35582466 PMCID: PMC9048271 DOI: 10.4330/wjc.v14.i4.206] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/28/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.
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Affiliation(s)
- A K M Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka 1207, Bangladesh
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38
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Dudorova E, Lavelle M, Lahey R, Ravalli S. Left Ventricular Metastases from Penile Squamous Cell Carcinoma. CASE 2022; 6:67-72. [PMID: 35492291 PMCID: PMC9050596 DOI: 10.1016/j.case.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cancer of the penis is rare in developed countries. Left ventricular metastases are very rare and not well documented. Complications of myocardial infiltration are tamponade, arrythmias, and myocardial rupture. Multimodal imaging is often necessary in the workup of cardiac masses.
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Affiliation(s)
- Elena Dudorova
- Department of Medicine, Norwalk Hospital–Yale University School of Medicine, Norwalk, Connecticut
| | - Michael Lavelle
- Department of Medicine, Division of Cardiology, New York–Presbyterian Hospital–Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ryan Lahey
- Department of Medicine, Division of Cardiology, New York–Presbyterian Hospital–Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Stefano Ravalli
- Department of Medicine, Division of Cardiology, New York–Presbyterian Hospital–Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Correspondence: Stefano Ravalli, MD, FACC, Division of Cardiology, New York–Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY 10032
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39
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Chang P, Xiao J, Hu Z, Kwan AC, Fan Z. Imaging of left heart intracardiac thrombus: clinical needs, current imaging, and emerging cardiac magnetic resonance techniques. Ther Adv Cardiovasc Dis 2022; 16:17539447221107737. [PMID: 35762763 PMCID: PMC9243573 DOI: 10.1177/17539447221107737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intracardiac thrombus in the left atrium and atrial appendage (LA/LAA) and left ventricle (LV) increases the risk of systemic thromboembolism and causes potentially devastating diseases such as ischemic stroke and acute ischemia in abdominal organs and lower extremities. Detecting the presence and monitoring the resolution of left heart intracardiac thrombus are of vital importance for stratifying patients and guiding treatment decisions. Currently, echocardiography is the most frequently used method for the above clinical needs, followed by computed tomography. An increasing number of studies have been performed to investigate the value of cardiac magnetic resonance (CMR) as an alternative imaging modality given its several unique strengths. This article provides an overview of the clinical relevance of the LA/LAA and LV thrombus as well as the diagnostic performance of the current imaging modalities and emerging CMR techniques.
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Affiliation(s)
- Peng Chang
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Cardiovascular, Lanzhou University Second Hospital, Lanzhou, China
| | - Jiayu Xiao
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Zhehao Hu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alan C Kwan
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zhaoyang Fan
- Department of Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC Room 104, Los Angeles, CA 90033, USA.,Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Biomedical Engineering, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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40
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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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41
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Asadian S, Rezaeian N, Hosseini L, Toloueitabar Y, Hemmati Komasi MM. The role of cardiac CT and MRI in the diagnosis and management of primary cardiac lymphoma: A comprehensive review. Trends Cardiovasc Med 2021; 32:408-420. [PMID: 34454052 DOI: 10.1016/j.tcm.2021.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/05/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022]
Abstract
Primary cardiac tumors comprise a distinct category of disorders that result in significant cardiac complications. Primary cardiac lymphomas (PCLs) constitute the second most frequent primary malignancy involving the heart. Without treatment, survival may be limited to just a few months; however, a timely therapeutic schedule may prolong the five-year survival. Accordingly, robust diagnostic modalities are essential to improve prognosis. We herein review the literature available in PubMed, MEDLINE, Cochrane, Google Scholar and Scopus databases. Our review demonstrated that cardiac computed tomography (CT) and magnetic resonance imaging (MRI) employ multiple advanced sequences for tumor characterization with or without a contrast agent. These methods assist not only in differentiating PCLs from other cardiac masses such as cardiac thrombi but also in defining the extent of PCLs and conducting a safe biopsy. Cardiac magnetic resonance (CMR) and CT imaging provide essential knowledge regarding PCLs and cardiotoxicity induced by therapeutic regimens. The application of these robust imaging modalities aids in the early diagnosis of PCLs, accelerates the initiation of the treatment program, and improves patient outcomes significantly. Also presented is our introduction into novel techniques and the feasibility of their use to diagnose and treat cardiac masses, particularly PCLs. It should be mentioned that the paramount role of FDG-PET was not the focus of this paper.
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Affiliation(s)
- Sanaz Asadian
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Nahid Rezaeian
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.
| | - Leila Hosseini
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
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42
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Artico J, Belgrano M, Bussani R, Sinagra G. The curious case of a massive right heart thrombosis: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab156. [PMID: 34377897 PMCID: PMC8343560 DOI: 10.1093/ehjcr/ytab156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/08/2020] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
Background Intraventricular masses are a relatively rare condition ranging from asymptomatic to potentially life-threatening situations. Case summary Herein, we report a case of a 49-year-old woman under investigation for a massive right ventricular (RV) mass who underwent complete investigation for possible differential diagnosis, in the suspect of RV tumour. Multimodality imaging with cardiac computed tomography and magnetic resonance imaging showed the presence of a massive thrombus partially obliterating the right ventricle. Surgical removal of the mass showed a large area of stratified thrombosis with an underlying area of endocardial fibrosis. The patient has been then discharged in good clinical condition and with lifetime oral anticoagulation. Discussion Massive RV thrombosis is a rare yet potentially fatal condition. Invasive management is preferable and lifetime anticoagulation is required to reduce possible downstream thrombotic complications.
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Affiliation(s)
- Jessica Artico
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata and University of Trieste, Via Pietro Valdoni 7, 34100 Trieste, Italy
| | - Manuel Belgrano
- Department of Radiology, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
| | - Rossana Bussani
- Department of Pathology, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata and University of Trieste, Via Pietro Valdoni 7, 34100 Trieste, Italy
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43
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Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology. Biomedicines 2021; 9:biomedicines9070774. [PMID: 34356838 PMCID: PMC8301302 DOI: 10.3390/biomedicines9070774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Primary malignant cardiac tumors are rare, with a prevalence of about 0.01% among all cancer histotypes. At least 60% of them are primary soft tissue sarcomas of the heart (pSTS-h) that represent almost 1% of all STSs. The cardiac site of origin is the best way to classify pSTS-h as it is directly linked to the surgical approach for cancer removal. Indeed, histological differentiation should integrate the classification to provide insights into prognosis and survival expectancy of the patients. The prognosis of pSTS-h is severe and mostly influenced by the primary localization of the tumor, the difficulty in achieving complete surgical and pharmacological eradication, and the aggressive biological features of malignant cells. This review aims to provide a detailed literature overview of the most relevant issues on primary soft tissue sarcoma of the heart and highlight potential diagnostic and therapeutic future perspectives.
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44
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Botrous C, Bioh G, Patel A, Hampson R, Senior R. Contrast echocardiography facilitates appropriate management of hospitalized patients with coronavirus disease 2019 (COVID-19) and suspected right ventricular masses: case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa575. [PMID: 34104860 PMCID: PMC8108614 DOI: 10.1093/ehjcr/ytaa575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/07/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) infection is associated with a coagulopathy with high incidence of venous thrombo-embolism. However, bleeding risk is also significant, causing difficulty in initiating and adjusting anticoagulation therapy in case of suspected thrombi. Cardiac masses can be challenging to be identified properly in the context of this disease. The use of bedside contrast echocardiography (CE) can be of a great value in this situation decreasing procedure-related risk and allowing proper diagnosis and management of a cardiac mass. Cases summary We present two cases who were admitted with severe COVID-19 infection. Both cases had additional risk factors for hypercoagulability. Un-enhanced echocardiography was performed and revealed right ventricular (RV) dysfunction with a suspected RV mass. The use of bedside CE could confirm a RV thrombus in the first case and exclude it in the second case. Hence, anticoagulation therapy could be adjusted accordingly in both patients. Discussion Coronavirus disease 2019 infection is associated with peripheral thrombo-embolism and cardiac thrombi. Given the critical condition of many patients affected by COVID-19, imaging for thrombo-embolic events is often restricted. With the use of bedside CE, cardiac masses may be correctly identified, aiding proper adjustment of anticoagulation therapy.
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Affiliation(s)
- Christina Botrous
- Northwick Park Hospital, Department of Cardiology and Cardiac Research Charity, Northwick Park Hospital, Harrow, UK
| | - Gabriel Bioh
- Northwick Park Hospital, Department of Cardiology and Cardiac Research Charity, Northwick Park Hospital, Harrow, UK
| | - Ashish Patel
- Northwick Park Hospital, Department of Cardiology and Cardiac Research Charity, Northwick Park Hospital, Harrow, UK
| | - Reinette Hampson
- Northwick Park Hospital, Department of Cardiology and Cardiac Research Charity, Northwick Park Hospital, Harrow, UK
| | - Roxy Senior
- Northwick Park Hospital, Department of Cardiology and Cardiac Research Charity, Northwick Park Hospital, Harrow, UK.,Department of Cardiology, Royal Brompton Hospital, London, UK.,Department of Cardiology, National Heart and Lung Institute, Imperial College, London, UK
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45
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Coroyer L, Garcon P, Duchatelle V, Azarine A. Interventricular septum mass presenting as a late acute coronary syndrome with ST-segment elevation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab164. [PMID: 34124566 PMCID: PMC8189305 DOI: 10.1093/ehjcr/ytab164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/05/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
Background Intracardiac masses are relatively rare but the diagnosis can be challenging for the cardiologist and the clinical presentation can be misleading. While most of the cardiac masses are benign, malignant masses are mostly metastatic tumours. Case summary An 81-year-old man was admitted to the cardiology department for congestive heart failure with the complaint of recent dyspnoea. The initial electrocardiogram was suggestive of a late presentation of an anterior myocardial infarction. Blood test showed mild and stable elevation of troponin and brain natriuretic peptide. Doppler-echocardiography revealed an interventricular septal thickening. Contrast echocardiography revealed a mass with a possibly necrotic centre and peripheral hypervascularization. Cardiac computed tomography (CT) confirmed the existence of a cardiac tumour with a hypodense centre and also revealed the presence of a large tumour of the lung’s left lower lobe with multiple enlarged lymph nodes associated with possible left adrenal gland metastasis. Computed tomography-guided percutaneous biopsy of the pulmonary mass demonstrated a squamous cell lung cancer which was likely the primary cancer. The patient was discharged home waiting for chemotherapy to start but died a few days later at home of an unknown cause. Discussion Diagnosis of intracardiac mass is difficult, often requiring multiple imaging modalities. Contrast-enhanced echocardiography may help early diagnosis and can be easily implemented with other imaging modalities such as cardiac magnetic resonance imaging or CT.
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Affiliation(s)
- Lucas Coroyer
- Cardiology Department, Hopital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
| | - Philippe Garcon
- Cardiology Department, Hopital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
| | - Veronique Duchatelle
- Pathology Department, Hopital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
| | - Arshid Azarine
- Radiology Department, Hopital Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France
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46
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Beale RA, Russo R, Beale C, Levin W, Atalay MK, Fingleton J, Poppas A, Apostolidou E. Mitral Valve Blood Cyst Diagnosed with the Use of Multimodality Imaging. ACTA ACUST UNITED AC 2021; 5:173-176. [PMID: 34195517 PMCID: PMC8236382 DOI: 10.1016/j.case.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Intracardiac blood cyst is a rare congenital abnormality that can be found in adults. It is most commonly attached in the valves, particularly the mitral valve. Echocardiography is the imaging modality of choice for the diagnosis of blood cyst. Cardiac MRI contributes to the diagnosis, typically showing absence of cyst enhancement. Conservative management is reasonable in the absence of effects on cardiac function.
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Affiliation(s)
| | - Ronald Russo
- Department of Medicine, SUNY Upstate, Syracuse, New York
| | - Charles Beale
- Hawthorne Medical Associates, Dartmouth, Massachusetts
| | - William Levin
- Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael K Atalay
- Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - James Fingleton
- Department of Cardiology and Cardiothoracic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Athena Poppas
- Department of Cardiology and Cardiothoracic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eirini Apostolidou
- Department of Cardiology and Cardiothoracic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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47
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Addetia K, Kruse E, Kim G, Guile B, Hipke K, Lang RM. A New Strategy for Left Ventricular Assist Device Outflow Graft Interrogation Using Ultrasound Contrast. J Am Soc Echocardiogr 2020; 34:445-447. [PMID: 33316397 DOI: 10.1016/j.echo.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Karima Addetia
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Eric Kruse
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Gene Kim
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Brittney Guile
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Kyle Hipke
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
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48
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Lindner JR. Contrast echocardiography: current status and future directions. Heart 2020; 107:18-24. [PMID: 33077502 DOI: 10.1136/heartjnl-2020-316662] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/04/2020] [Accepted: 09/21/2020] [Indexed: 12/17/2022] Open
Abstract
Contrast echocardiography is a family of ultrasound-based procedures, whereby acoustic enhancing agents, usually microbubbles, are administered by intravenous route and detected in order to improve diagnostic performance. This review describes: (1) the agents that have been designed for diagnostic imaging, (2) current clinical applications where either left ventricular opacification or microvascular perfusion imaging with myocardial contrast echocardiography have been demonstrated to provide incremental information to non-contrast echocardiography and (3) future diagnostic and therapeutic applications of contrast ultrasound that rely on unique compositional design of ultrasound-enhancing agents.
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Affiliation(s)
- Jonathan R Lindner
- Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon, USA
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49
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Shi Y, Duan S, Zhang L, Bai X, Ban C, Wang Y, Zhang X. A primary benign cardiac tumor misdiagnosed as cardiac metastasis in the right atrium. Echocardiography 2020; 37:1678-1681. [PMID: 32944966 DOI: 10.1111/echo.14805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022] Open
Abstract
We present a patient with breast cancer with multiple metastases who had an unusual cardiac mass in the right atrium. The cardiac mass was initially diagnosed as malignant metastasis by transthoracic echocardiogram (TTE) but subsequently diagnosed as benign by contrast-enhanced ultrasonography, cardiac magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT). TTE is the preferred imaging method for examination of cardiac masses. However, this case demonstrates that contrast-enhanced ultrasonography, MRI, and PET/CT are useful to differentiate between diagnoses of benign and malignant tumor. The combination of multiple diagnostic imaging modalities is necessary to confirm the diagnosis of cardiac tumors.
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Affiliation(s)
- YiLu Shi
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - ShaSha Duan
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.,Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Zhang
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xia Bai
- Department of Magnetic Resonance Imaging, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Chao Ban
- Department of Nuclear Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - YaXi Wang
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - XiaoShan Zhang
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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50
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Hameed A, Lashin H, Khanji MY, Spiritoso R. Eosinophilic Myocarditis Secondary to T-Cell Lymphoma Complicated by Left Ventricular Thrombus and Tear. JACC Case Rep 2020; 2:1954-1958. [PMID: 34317088 PMCID: PMC8299135 DOI: 10.1016/j.jaccas.2020.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022]
Abstract
We describe a 54-year-old male in whom eosinophilic myocarditis secondary to T-cell lymphoma complicated by bilateral ischemic stroke was diagnosed. The source, identified as an apical tear with thrombus formation, was revealed by transthoracic echocardiography. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Aisha Hameed
- Adult Critical Care Unit, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Hazem Lashin
- Adult Critical Care Unit, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Mohammed Y Khanji
- William Harvey Research Institute, Queen Mary University, London, United Kingdom.,Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Rosalba Spiritoso
- Adult Critical Care Unit, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
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