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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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Stiru O, Geana RC, Dragulescu PR, Tulin A, Raducu L, Bacalbasa N, Balescu I, Cretoiu D, Diaconu C, Iliescu L, Savu C, Iliescu VA. Transapical Left Ventricular Approach for Cardiac Papillary Fibroelastomas: A Case Report. In Vivo 2021; 34:3681-3685. [PMID: 33144485 DOI: 10.21873/invivo.12216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Cardiac papillary fibroelastomas (CPF) are benign tumors, frequently asymptomatic, characterized by a mobile pedunculated mass that arises from the endocardium. When CPF is located in the left ventricle, it may protrude into the left ventricular outflow tract and affect hemodynamics. They are highly thrombogenic, and can also cause some life-threatening events such as cerebral and peripheral embolization. CASE REPORT We herein report a case of a 74-year-old female admitted to our center with palpitations and dyspnea on exertion. Her past medical history revealed that she had had a transient ischemic attack 7 months before presentation. Echocardiography and cardiac magnetic resonance imaging revealed an intracardiac mass anchored in the anteroapical interventricular septum without interference with aortic or mitral valve functionality. Surgical resection of the left ventricular mass was performed through the left apical ventriculotomy approach. Histopathological examination of the tumor was suggestive of papillary fibroelastoma. The postoperative course was uneventful. The patient was discharged home on the eighth postoperative day, with no recurrence at 6 months. CONCLUSION Although left ventricular papillary fibroelastomas are benign tumors, they carry a high risk for embolic complications and therefore surgery should be proposed, the transapical approach being a safe and effective method.
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Affiliation(s)
- Ovidiu Stiru
- Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roxana Carmen Geana
- Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | | | - Adrian Tulin
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery, Prof. Dr. Agripa Ionescu, Clinical Emergency Hospital, Bucharest, Romania
| | - Laura Raducu
- Department of Plastic and Reconstructive Microsurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Plastic and Reconstructive Surgery, Prof Dr. Agripa Ionescu, Clinical Emergency Hospital, Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania .,Department of Obstetrics and Gynecology, I. Cantacuzino Clinical Hospital, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania
| | - Dragos Cretoiu
- Department of Cellular, Molecular and Histology Biology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Scientific researcher, Alessandrescu-Rusescu National Institute of Mother and Child Health, Fetal Medicine Excellence Research Center, Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Laura Iliescu
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Cornel Savu
- Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Thoracic Surgery, Marius Nasta Institute of Pneumonology, Bucharest, Romania
| | - Vlad Anton Iliescu
- Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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de Klerk S, Dogon C, Grossman M, Adler JE, McFalls J, Furukawa S, Goldberg S. Left Ventricular Papillary Fibroelastoma Presenting with Dyspnea on Exertion. ACTA ACUST UNITED AC 2020; 4:278-282. [PMID: 32875195 PMCID: PMC7451855 DOI: 10.1016/j.case.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A patient presented with reduced effort tolerance and abnormal stress test. He was subsequently found to have a left ventricular mass. Multimodal imaging was utilized; however, diagnostic certainty remained limited. Cardiac surgery was pursued, wherein a single left ventricular mass was resected. Biopsy was consistent with cardiac papillary fibroelastoma. On follow-up, the patient reported a return to prior functioning.
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Affiliation(s)
- Storm de Klerk
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Calli Dogon
- Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Moshe Grossman
- Department of Radiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeremy E Adler
- Department of Pathology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jeanne McFalls
- Department of Pathology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Satoshi Furukawa
- Cardiovascular Surgery, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Sheldon Goldberg
- Cardiovascular Education, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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