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Teske AJ, Jimenez-Rodriguez GM, Kraaijeveld AO, Broekhuizen LN, van Osch D, Gort EH, Rhenen AV, Harst PV, Voskuil M. Intracardiac echocardiography-guided biopsies for right-sided intracardiac tumors: An optimized diagnostic algorithm and case illustrations. Catheter Cardiovasc Interv 2024; 104:862-868. [PMID: 39162288 DOI: 10.1002/ccd.31189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/27/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024]
Abstract
Intracardiac tumors, though uncommon, necessitate a swift and accurate diagnosis for personalized treatment and prognosis estimation. While multi-modality imaging often determines the etiology of these cardiac masses, histological confirmation remains essential for definitive diagnosis and its specific treatment. Since cardiac tumors are often found in high-risk locations (ventricular free wall or atria), precision biopsy is paramount. The least invasive strategy would be to achieve this by means of endomyocardial biopsy (EMB); however real-time additional imaging is essential to reduce the risk of perforation/tamponade and to minimize sampling error. Intracardiac echocardiography (ICE) emerges as an excellent tool to achieve this goal preventing procedural complications and reducing the likelihood of sampling errors obtaining a definitive histopathological diagnosis in all cases. This paper outlines our diagnostic algorithm for optimal patient selection, details three illustrative cases, and elucidates the steps to acquire histopathology via percutaneous transvenous biopsy with ICE guidance in patients with right-sided cardiac tumors. Given the rarity of intracardiac tumors, we advocate these patients be managed by a dedicated multidisciplinary cardio-oncology team including an interventional cardiologist.
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Affiliation(s)
- Arco J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Gian-Manuel Jimenez-Rodriguez
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
- Department of Interventional Cardiology , National Institute of Cardiology, Ignacio Chavez, Mexico City, Mexico
| | - Adriaan O Kraaijeveld
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Lysette N Broekhuizen
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
- Department of Cardiology , Central Military Hospital, Utrecht, The Netherlands
| | - Dirk van Osch
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Eelke H Gort
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Anna V Rhenen
- Department of Hematology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Pim Vd Harst
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
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2
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Bonne L, Van Herpe F, Verslype C, Peluso J, Maleux G. Percutaneous Transhepatic Endovascular Biopsy of an Extrahepatic Portal Vein Mass Using a Colapinto Needle with Concomitant Portal Vein Stent Placement. J Vasc Interv Radiol 2022; 34:729-731. [PMID: 36584807 DOI: 10.1016/j.jvir.2022.12.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/12/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Affiliation(s)
- Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Filip Van Herpe
- Department of Clinical Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Chris Verslype
- Department of Clinical Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Jo Peluso
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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3
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Woods MA, Knavel Koepsel EM, Swietlik JF, Shin DS, Chick JFB, Weaver JJ, Watts MM, Laeseke P, Kleedehn MG, Monroe EJ. Intravascular US: Applications in Interventional Radiology. Radiographics 2022; 42:1742-1757. [PMID: 36190846 DOI: 10.1148/rg.220015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Interventional radiology applications of intravascular US (IVUS) continue to expand, complementing intraprocedural angiography and providing a unique vantage from which to guide endovascular interventions. Vascular pathologic conditions become sonographically visualized rather than inferred from the planar appearance of the opacified vascular lumen. Perivascular targets become sonographically visualized rather than approximated on the basis of fluoroscopic landmarks. The authors introduce broad categories of IVUS catheters, namely radial and side-firing varieties, as well as prevailing options for each and their technical specifications. Common applications within interventional radiology are covered in a systems approach, including deep venous thrombosis, May-Thurner syndrome, nutcracker syndrome, transjugular intrahepatic portosystemic shunts, aortic interventions, peripheral arterial disease, and endovascular or perivascular biopsy. Discussions are accompanied by technical pearls from the authors, and summarized evidence where IVUS has been shown to reduce procedural time, intravascular contrast agent dose, radiation exposure, and morbidity in each space is presented. Finally, emerging applications and future directions are discussed. ©RSNA, 2022.
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Affiliation(s)
- Michael A Woods
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Erica M Knavel Koepsel
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - John F Swietlik
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - David S Shin
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Jeffrey Forris Beecham Chick
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - John J Weaver
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Micah M Watts
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Paul Laeseke
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Mark G Kleedehn
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
| | - Eric J Monroe
- From the Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, 600 Highland Ave, Madison, WI 53792 (M.A.W., E.M.K.K., J.F.S., P.L., M.G.K., E.J.M.); Department of Radiology, Section of Vascular and Interventional Radiology (D.S.S., J.F.B.C., J.J.W.), and Deep Vein Institute (D.S.S., J.F.B.C.), University of Washington, Seattle, Wash; and Atlantic Medical Imaging Vascular Institute, Vineland, NJ (M.M.W.)
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Mahalwar G, Barve N, Furqan MM, Reyaldeen RM, Kumar A, Collier P, Klein AL. Role of Echocardiography in Diagnosing Metastatic Testicular Carcinoma in a Young Patient Presenting as Right Heart Failure. CASE 2022; 6:63-66. [PMID: 35492298 PMCID: PMC9050579 DOI: 10.1016/j.case.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Metastatic GCTs may initially present as right heart failure. TTE and TEE can diagnose cardiac metastasis and monitor cardiac function. Multimodality imaging informs about tumor burden in metastatic cardiac tumors.
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Affiliation(s)
| | | | - Muhammad M. Furqan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Reza M. Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ashwin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Collier
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- Reprint requests: Allan L. Klein, MD, Pericardial Disease Center, Department of Cardiovascular Medicine Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195.
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5
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Chang L, Gong C, Lu H, Liu Y, Kang L, Chen J, Wang L, Xu B. Percutaneous intravenous catheter forceps biopsy in right atrial mass: two case reports and literature review. BMC Cardiovasc Disord 2022; 22:63. [PMID: 35184743 PMCID: PMC8859873 DOI: 10.1186/s12872-022-02507-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/10/2022] [Indexed: 12/17/2022] Open
Abstract
Background Primary malignant tumors of the heart are rare. Although preoperative histological diagnosis is difficult, it has paramount value in therapeutic strategy development and prognostic estimation. Herein, we reported 2 cases of intracardiac tumors. Cases presentation Both patients presented to the hospital with heart-related symptoms. Echocardiography showed massive masses in the atrium and positron emission tomography–computed tomography (PET/CT) revealed hypermetabolism and invasiveness. One patient cannot take surgery due to extensive metastasis and poor condition. The other patient was primarily diagnosed with lymphoma, and surgery was not recommended. They successfully underwent intravenous atrial biopsy, and histological samples confirmed intimal sarcoma and diffuse large B cell lymphoma. Based on immunohistochemical and molecular assessments, targeted chemotherapy was administered, resulting in clinical and imaging remission at discharge. Conclusions Percutaneous intravenous catheter biopsy as a safe invasive test provides an accurate pathological diagnosis after imaging evaluation, and offers a therapeutic direction. Nonmalignant masses and some chemo-radiosensitive malignant tumors in the atrium could have good prognosis after targeted therapy.
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6
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Zhang DL, Chen S, Lin YC, Wu SS. Primary cardiac lymphoma (PCL): Report of a Case Diagnosed by Ultrasound-Guided percutaneous Core Needle Biopsy. J Vasc Interv Radiol 2022; 33:611-614. [PMID: 35121095 DOI: 10.1016/j.jvir.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/27/2021] [Accepted: 01/22/2022] [Indexed: 10/19/2022] Open
Affiliation(s)
- Dan-Ling Zhang
- ,Department of Ultrasonography,Shengli Clinical college of Fujian Medical University, Fuzhou No.7 hospital,Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography,Shengli Clinical college of Fujian Medical University,Fujian Provincial Hospital,Fuzhou,China
| | - Yu-Cheng Lin
- ,Department of Ultrasonography,Shengli Clinical college of Fujian Medical University,Fujian Medical University Affiliated Fuzhou First Hospital,Fuzhou,China
| | - Song-Song Wu
- Department of Ultrasonography,Shengli Clinical college of Fujian Medical University,Fujian Provincial Hospital,Fuzhou,China.
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7
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Pearman JL, Wall SL, Chen L, Rogers JH. Intracardiac echocardiographic-guided right-sided cardiac biopsy: Case series and literature review. Catheter Cardiovasc Interv 2021; 98:1000-1005. [PMID: 33002282 DOI: 10.1002/ccd.29302] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022]
Abstract
Endomyocardial biopsy (EMB) is a common procedure used to aid in the diagnosis of diffuse myocardial diseases and, less commonly, in the diagnosis of cardiac tumors. As cardiac tumors are often found in high-risk locations (ventricular free wall or atria), precision biopsy is paramount, and additional imaging, like transesophageal echocardiography is often required for guidance. The use of intracardiac echocardiography (ICE) to guide biopsy has been described, but there is no consensus on a standardized approach. We report our institutional approach with three cases of ICE-directed EMB performed with the 2.4 mm Jawz bioptome directed with an 8.5-Fr Agilis NxT steerable introducer. All cases were performed under guidance with the AcuNav ICE probe. There were no procedural complications and a definitive diagnosis was obtained in all three cases. We also review the available published cases of ICE-guided EMB in the literature-noting the different procedural approaches, complication rate, and diagnostic yield. There were only two negative biopsies reported among the published cases and no reported complications. Our review of all these cases suggests that ICE-guidance for EMB is superior to other forms of imaging in its ease of use and high definition of right-sided cardiac structures. We also feel that the use of the Agilis steerable sheath allows for more precise directing of the bioptome and is a critical component in performing a successful targeted biopsy.
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Affiliation(s)
- Joseph L Pearman
- Internal Medicine, UC Davis Medical Center, Sacramento, California
| | - Stephen L Wall
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Lily Chen
- Internal Medicine, UC Davis Medical Center, Sacramento, California.,Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
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8
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Swenson C, Martin JG, Jaffe T, Gupta RT, Sag AA, Befera NT, Pabon-Ramos WM, Suhocki PV, Smith TP, Kim CY, Ronald J. Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience. J Vasc Interv Radiol 2021; 32:1310-1318.e2. [PMID: 34058351 DOI: 10.1016/j.jvir.2021.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/23/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To report initial clinical experience with intravascular ultrasound (US)-guided transvenous biopsy (TVB) for perivascular target lesions in the abdomen and pelvis using side-viewing phased-array intracardiac echocardiography catheters. MATERIALS AND METHODS In this single-institution, retrospective study, 48 patients underwent 50 intravascular US-guided TVB procedures for targets close to the inferior vena cava or iliac veins deemed difficult to access by conventional percutaneous needle biopsy (PNB). In all procedures, side-viewing phased-array intracardiac echocardiography intravascular US catheters and transjugular liver biopsy sets were inserted through separate jugular or femoral vein access sheaths, and 18-gauge core needle biopsy specimens were obtained under real-time intravascular US guidance. Diagnostic yield, diagnostic accuracy, and complications were analyzed. RESULTS Intravascular US-guided TVB was diagnostic of malignancy in 40 of 50 procedures for a diagnostic yield of 80%. There were 5 procedures in which biopsy was correctly negative for malignancy, with a per-procedure diagnostic accuracy of 90% (45/50). Among the 5 false negatives, 2 patients underwent repeat intravascular US-guided TVB, which was diagnostic of malignancy for a per-patient diagnostic accuracy of 94% (45/48). There were 1 (2%) mild, 2 (4%) moderate, and 1 (2%) severe adverse events, with 1 moderate severity adverse event (venous thrombosis) directly attributable to the intravascular US-guided TVB technique. CONCLUSIONS Intravascular US-guided TVB performed on difficult-to-approach perivascular targets in the abdomen and pelvis resulted in a high diagnostic accuracy, similar to accepted thresholds for PNB. Complication rates may be slightly higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy.
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Affiliation(s)
- Christopher Swenson
- Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Jonathan G Martin
- Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Tracy Jaffe
- Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Rajan T Gupta
- Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Alan A Sag
- Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Nicholas T Befera
- Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Waleska M Pabon-Ramos
- Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Paul V Suhocki
- Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Tony P Smith
- Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Charles Y Kim
- Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - James Ronald
- Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, North Carolina.
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9
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Computed tomographically guided transthoracic biopsy of a cardiac mass in the right ventricular outflow tract. J Thorac Cardiovasc Surg 2019; 159:e115-e118. [PMID: 31256959 DOI: 10.1016/j.jtcvs.2019.05.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022]
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10
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Gioia M, Alawieh H, Amoun T, Bangash A, Horgan S, Uretsky S, Safirstein J. A Rare Case of Primary Intracardiac Diffuse Large B-Cell Lymphoma: Multimodality Imaging to the Rescue. CASE (PHILADELPHIA, PA.) 2019; 3:133-136. [PMID: 31286095 PMCID: PMC6588832 DOI: 10.1016/j.case.2019.02.002] [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: 10/26/2022]
Abstract
•Primary cardiac malignancies are extremely rare and lethal. •Early diagnosis with multimodality imaging and treatment are crucial. •Survival with primary cardiac lymphoma is typically <1 month without treatment.
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Affiliation(s)
- Mario Gioia
- Department of Internal Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Hassan Alawieh
- Department of Internal Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Tarek Amoun
- Department of Internal Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Areeb Bangash
- Department of Internal Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Stephen Horgan
- Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Seth Uretsky
- Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Jordan Safirstein
- Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
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11
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Kumar M, Tigadi S, Azrin MA, Kim AS. Multimodality Imaging of a Right Atrial Cardiac Mass. Cureus 2019; 11:e4705. [PMID: 31355065 PMCID: PMC6649882 DOI: 10.7759/cureus.4705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Work up of a right atrial mass usually requires multimodality imaging and sometimes a biopsy to affirm histological diagnosis. We present a case of a 74-year-old woman with primary cutaneous melanoma (wildtype BRAF) of the right toe who was found to have a large heterogeneous mass in the right atrium on routine surveillance CT scan. She did not have any cardiac symptoms. Vital signs and physical examination were unremarkable. Cardiac magnetic resonance (CMR) imaging demonstrated a bilobed mass with an intramural component and a mobile blood pool component, with interposed thrombus. Three-dimensional transesophageal echocardiogram (3D-TEE) revealed the mass and its site of attachment on the lateral wall of the right atrium. Given the large size of the tumor and its potential for obstruction of tricuspid inflow, the right atrial mass was surgically resected. Pathology confirmed metastatic melanoma. The patient tolerated cardiac surgery well and was discharged shortly thereafter. In the present case, a large cardiac metastasis was discovered in the absence of clinically detectable disease elsewhere. CMR allowed a comprehensive evaluation of the location, extension, and tissue characterization of the cardiac mass. Transthoracic echocardiogram (TTE) and 3D-TEE allowed assessment of the hemodynamic consequences of this mass and aided in operative planning.
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Affiliation(s)
- Manish Kumar
- Internal Medicine, University of Connecticut Health Center, Farmington, USA
| | - Supriya Tigadi
- Cardiology, University of Connecticut Health Center, Farmington, USA
| | - Michael A Azrin
- Cardiology, University of Connecticut Health Center, Farmington, USA
| | - Agnes S Kim
- Cardiology, University of Connecticut Health Center, Farmington, USA
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12
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Chick JFB, Roush BB, Khaja MS, Prohaska D, Cooper KJ, Saad WE, Srinivasa RN. Transbiliary intravascular ultrasound-guided diagnostic biopsy of an inaccessible pancreatic head mass. Radiol Case Rep 2017; 12:323-326. [PMID: 28491180 PMCID: PMC5417622 DOI: 10.1016/j.radcr.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/02/2017] [Indexed: 12/17/2022] Open
Abstract
Percutaneous image-guided biopsies of pancreatic malignancies may prove challenging and nondiagnostic due to a variety of anatomic considerations. For patients with complex post-surgical anatomy, such as a Roux-en-Y gastric bypass, diagnosis via endoscopic ultrasound with fine-needle aspiration may not be possible because of an inability to reach the proximal duodenum. This report describes the first diagnostic case of transbiliary intravascular ultrasound-guided biopsy of a pancreatic head mass in a patient with prior Roux-en-Y gastric bypass for which a diagnosis could not be achieved via percutaneous and endoscopic approaches. Transbiliary intravascular ultrasound-guided biopsy resulted in a diagnosis of pancreatic adenocarcinoma, allowing the initiation of chemotherapy.
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Affiliation(s)
- Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Benjamin B Roush
- Western Michigan University School of Medicine, Kalamazoo, MI, USA
| | - Minhaj S Khaja
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Dennis Prohaska
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kyle J Cooper
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Wael E Saad
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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13
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Sun BJ, Lee JH. Intracardiac echocardiography for guiding biopsy of cardiac tumors: a novel noninvasive technique. Interv Cardiol 2015. [DOI: 10.2217/ica.15.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Park KI, Kim MJ, Oh JK, Lee JH, Park JH, Choi SW, Jeong JO, Seong IW. Intracardiac echocardiography to guide biopsy for two cases of intracardiac masses. Korean Circ J 2015; 45:165-8. [PMID: 25810740 PMCID: PMC4372984 DOI: 10.4070/kcj.2015.45.2.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/18/2014] [Accepted: 07/22/2014] [Indexed: 11/11/2022] Open
Abstract
Pathologic diagnosis of a cardiac mass is vital in determining the proper treatment modality. Open heart surgery or transesophageal echocardiography guided biopsy can be feasible methods to confirm the pathology. However, the former is highly invasive and both methods require general anesthesia. The introduction of intracardiac echocardiography (ICE) can provide good anatomic information of heart and does not require general anesthesia. In this report, we present two cases of cardiac tumors which were confirmed by percutaneous biopsy under the guidance of an ICE. The patients underwent cardiac biopsy without any complications.
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Affiliation(s)
- Kwang-In Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Mi Joo Kim
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Kyung Oh
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Si Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - In-Whan Seong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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15
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Thakrar PD, Petersen BD, Kaufman JA. Intravascular ultrasound for transvenous interventions. Tech Vasc Interv Radiol 2014; 16:161-7. [PMID: 23993078 DOI: 10.1053/j.tvir.2013.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since the development of intravascular ultrasound in the late 1980s, the modality has been used both to image the vascular system and to direct interventions in target vessels. Intravascular ultrasound (IVUS) was initially used to image atherosclerosis and aid in its treatment, but it has more recently been employed within the venous system, allowing for both intravenous and transvenous image-guided interventions. IVUS is now used for both direct and transjugular intrahepatic portosystemic shunt placement, for transcaval liver biopsy and transcaval puncture of type II endoleaks, and for cardiac mass biopsy, among other interventions. The use of IVUS not only yields potential for reduced fluoroscopy dose in and increased safety of established procedures, but it also allows for the development of altogether new procedures.
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Affiliation(s)
- Pooja D Thakrar
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR 97239, USA.
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Huo JL, Choi JC, DeLuna A, Lee D, Fleischmann D, Berry GJ, Deuse T, Haddad F. Cardiac Paraganglioma: Diagnostic and Surgical Challenges. J Card Surg 2012; 27:178-82. [DOI: 10.1111/j.1540-8191.2011.01378.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Barker PCA. Intracardiac echocardiography in congenital heart disease. J Cardiovasc Transl Res 2009; 2:19-23. [PMID: 20559965 DOI: 10.1007/s12265-009-9088-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 01/07/2009] [Indexed: 11/30/2022]
Abstract
The use of intracardiac echocardiography (ICE) in congenital heart disease has become well established over the past 7 years since its introduction into clinical imaging. The greatest experience has been to guide percutaneous device closures of secundum atrial septal defects and patent foramen ovale, with excellent safety and clinical results. However, ICE has also been used for the evaluation and management of many other congenital heart defects given its unique blood/transducer interface and close proximity to relevant cardiac anatomy. Clinical application of ICE is expanding, with the current ICE catheters being used as micro-transesophageal echo probes, and three-dimensional prototypes already developed and tested in animal models. It is expected that ICE will further increase in use with refinements in technology and greater operator experience, aiding the management of complex congenital heart disease.
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Affiliation(s)
- Piers C A Barker
- The Duke Children's Heart Program, Duke University Medical Center, Room 7502D-Duke Hospital North, Durham, NC 27710, USA.
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