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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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Shu S, Yuan H, Kong X, Wang J, Wang J, Zheng C. The value of multimodality imaging in diagnosis and treatment of cardiac lipoma. BMC Med Imaging 2021; 21:71. [PMID: 33858367 PMCID: PMC8048252 DOI: 10.1186/s12880-021-00603-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Background Cardiac lipoma is a rare primary tumor in the heart and pericardium. Multimodality imaging methods, especially magnetic resonance imaging (MRI), are crucial in detecting and diagnosing cardiac lipomas. Besides, they are of significant importance in management of cardiac lipomas. The aim of this study was to evaluate the value of multimodality imaging methods in diagnosing and treatment of cardiac lipoma by describing a series of cases of cardiac lipoma. Materials and methods Data of patients with cardiac lipoma at a local institution were retrospectively collected. Their imaging findings on echocardiography, computed tomography (CT), and cardiac MRI and clinical management were described in detail. Results 12 patients with cardiac lipoma were retrospectively included with thirteen lipomas found within heart and pericardium. Two patients’ lipoma were symptomatic, while lipomas in other 10 patients were found incidentally. Most lipomas were sensitively detected with echocardiography. Accurate diagnoses were achieved with CT and MRI in all cases. Surgical resection was performed in one symptomatic patient due to the obstruction of the left ventricular outflow tract, while the removal of pericardial lipoma in another symptomatic patient was not possible due to diffuse myocardial infiltration observed in MRI. Based on MRI findings, two patients without clinical symptoms also underwent surgery to prevent the risk of detachment of ventricular lipoma with a narrow pedicle in one patient and potential further thinning of the myocardium by pericardial lipoma growth in another patient. Conclusions Cardiac lipoma could be sensitively detected and accurately diagnosed with multiple noninvasive imaging tools. Comprehensive evaluation with multimodality imaging methods should also be conducted for better management planning and follow-up in all patients.
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Affiliation(s)
- Shenglei Shu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Hongliang Yuan
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jiazheng Wang
- Clinical and Technical Solutions, Philips Healthcare, Beijing, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Ave, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
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3
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Right ventricular outflow tract endocarditis caused by brucellosis. J Infect Public Health 2017; 10:678-680. [DOI: 10.1016/j.jiph.2016.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 09/10/2016] [Indexed: 11/22/2022] Open
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Wang JG, Liu B, Gao H, Li YJ, Zhao P, Liu XP. Primary Cardiac Osteosarcoma. Heart Lung Circ 2016; 25:698-704. [PMID: 26907617 DOI: 10.1016/j.hlc.2016.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/31/2015] [Accepted: 01/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary cardiac osteosarcoma is extremely rare. There is no cohort study on such tumours to date. The aim of this study is to investigate the clinical characteristics and outcome patterns of such tumours. METHODS A thorough literature review was performed, and all relevant clinical items were collected. A total of 53 cases of primary cardiac osteosarcoma were enrolled in this study, including 25 males and 28 females. RESULTS The age at diagnosis ranged from 14 to 77 years with a mean age of 43.6 years. The clinical manifestations, imaging features, and laboratory tests of the primary cardiac osteosarcomas were similar to other types of primary cardiac tumours. Sex, tumour size and adjunctive chemo-radiotherapy were found to affect the overall survival pattern. CONCLUSIONS The present study may provide an effective consultation for the diagnosis and treatment of this tumour.
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Affiliation(s)
- Ji-Gang Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, People's Republic of China; Department of Pathology, School of Basic Medical Sciences, Fudan University, People's Republic of China
| | - Bing Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, People's Republic of China
| | - Han Gao
- Department of Pathology, Qingdao Municipal Hospital, People's Republic of China
| | - Yu-Jun Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, People's Republic of China
| | - Peng Zhao
- Department of Pathology, The Affiliated Hospital of Qingdao University, People's Republic of China
| | - Xiu-Ping Liu
- Department of Pathology, The Fifth Peoples' Hospital of Shanghai, Fudan University, People's Republic of China; Department of Pathology, School of Basic Medical Sciences, Fudan University, People's Republic of China.
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Fang L, He L, Chen Y, Xie M, Wang J. Infiltrating Lipoma of the Right Ventricle Involving the Interventricular Septum and Tricuspid Valve: Report of a Rare Case and Literature Review. Medicine (Baltimore) 2016; 95:e2561. [PMID: 26817909 PMCID: PMC4998283 DOI: 10.1097/md.0000000000002561] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/21/2015] [Accepted: 12/28/2015] [Indexed: 12/12/2022] Open
Abstract
Cardiac lipoma, which are primary cardiac tumors, are rare entities often detected incidentally during imaging. There have been very few reports on the right ventricle (RV) lipoma. Here, we present a case of RV infiltrating lipoma involving the interventricular septum (IVS) and the tricuspid valve. Clinical symptoms, diagnostic procedures, multimodality imaging characteristics, and treatment are discussed, and the complete clinical data of this case and relevant details of retrospective literature are reviewed. The study described the case of a 48-year-old woman who suffered from occasional palpitation after exertion for 10 years. Imaging examinations, including echocardiography and cardiovascular magnetic resonance imaging (MRI), revealed a large mass adherent to the IVS and the right ventricular wall that was consistent with lipoma. The patient underwent surgical repair of the tricuspid valve and excision of the partial mass. The gross specimen revealed piles of 5 × 4 × 3 cm fragments with yellowish appearance and pathological results showed infiltrating lipoma.Lipoma is often asymptomatic and diagnosed incidentally. Surgical excision is the main therapeutic intervention, which is always performed in cases of symptomatic lipoma or when malignancy is suspected. Multimodality imaging would be great help in the diagnosis of cardiac lipoma. Echocardiography is a convenient method for follow-up.
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Affiliation(s)
- Lingyun Fang
- From the Department of Ultrasound (LF, LH, MX, JW); and Department of Radiology (YC), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wang JG, Cui L, Jiang T, Li YJ, Wei ZM. Primary cardiac leiomyosarcoma: an analysis of clinical characteristics and outcome patterns. Asian Cardiovasc Thorac Ann 2015; 23:623-30. [PMID: 25740020 DOI: 10.1177/0218492315574197] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary cardiac leiomyosarcoma is an extremely rare entity. There is no accumulated knowledge about the clinical characteristics and therapeutic strategies for this tumor. This study aimed to systematically review the available literature to investigate the clinicoradiologic and clinicopathologic characteristics, treatment, and outcomes in patients with primary cardiac leiomyosarcoma. METHODS We identified 79 instances derived from 72 unique reports and carefully analyzed all clinical presentations, imaging, pathology, treatments, and outcomes. RESULTS The mean age at onset was 48 years. A symptom of obstruction was the most frequent complaint at diagnosis. Routine imaging methods such as echocardiography, computed tomography, and magnetic resonance imaging had high sensitivity in diagnosis. The tumor has a poorer life expectancy than its counterparts in other sites. The 5-year overall survival and recurrence-free survival rates were 25.4% and 14.7%, respectively. Overall survival was affected by age, surgery, and adjunctive chemotherapy or radiotherapy. CONCLUSIONS Our findings suggest that primary cardiac leiomyosarcomas tend to be biologically more aggressive compared to their counterparts in other sites. However, complete resection and adjunctive chemotherapy or radiotherapy may help to increase the life expectancy.
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Affiliation(s)
- Ji-Gang Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Cui
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tao Jiang
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu-Jun Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhi-Min Wei
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
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7
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Nelson JS, Jackson AL, Darling JM, Gerber DA. Chest pain and progressive shortness of breath in a 60-year-old woman following liver transplantation. Chest 2011; 139:464-468. [PMID: 21285064 DOI: 10.1378/chest.09-2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jennifer S Nelson
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC.
| | - Autumn L Jackson
- Division of Hematology/Oncology, University of North Carolina Hospitals, Chapel Hill, NC
| | - Jama M Darling
- Division of Gastroenterology and Hepatology, University of North Carolina Hospitals, Chapel Hill, NC
| | - David A Gerber
- Department of Surgery, Lineberger Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
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8
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Funt S, Lerakis S, McLean DS, Willis P, Book W, Martin RP. A right atrial mass, patent foramen ovale, and indwelling central venous catheter in a patient with a malignancy: a diagnostic and therapeutic dilemma. J Am Soc Echocardiogr 2009; 23:457.e1-3. [PMID: 19879732 DOI: 10.1016/j.echo.2009.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Indexed: 11/26/2022]
Abstract
A 33-year-old woman with a history of gestational trophoblastic disease presented for investigation of a right atrial mass. She had been receiving chemotherapy administered via a Port-a-Cath system for 2 months prior to presentation. On transesophageal echocardiography and magnetic resonance imaging, she was found to have a mass attached to the right atrial free wall, with a segment projecting across a patent foramen ovale. Because of the risk for an embolic event, the mass was surgically removed and the patent foramen ovale repaired. Pathology showed an organized thrombus. This case emphasizes the need for high suspicion for thrombus when a right atrial mass is found in a patient with a hypercoagulable state due to underlying malignancy who has a central venous catheter.
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Affiliation(s)
- Samuel Funt
- Division of Cardiology, Department of Medicine, Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography. J Am Soc Echocardiogr 2009; 21:1179-201; quiz 1281. [PMID: 18992671 DOI: 10.1016/j.echo.2008.09.009] [Citation(s) in RCA: 312] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
UNLABELLED ACCREDITATION STATEMENT: The American Society of Echocardiography (ASE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASE designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit.trade mark Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Registry of Diagnostic Medical Sonographers and Cardiovascular Credentialing International recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The ASE is committed to resolving all conflict-of-interest issues, and its mandate is to retain only those speakers with financial interests that can be reconciled with the goals and educational integrity of the educational program. Disclosure of faculty and commercial support sponsor relationships, if any, have been indicated. TARGET AUDIENCE This activity is designed for all cardiovascular physicians, cardiac sonographers, and nurses with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, sonographers, and other medical professionals having a specific interest in contrast echocardiography may be included. OBJECTIVES Upon completing this activity, participants will be able to: 1. Demonstrate an increased knowledge of the applications for contrast echocardiography and their impact on cardiac diagnosis. 2. Differentiate the available ultrasound contrast agents and ultrasound equipment imaging features to optimize their use. 3. Recognize the indications, benefits, and safety of ultrasound contrast agents, acknowledging the recent labeling changes by the US Food and Drug Administration (FDA) regarding contrast agent use and safety information. 4. Identify specific patient populations that represent potential candidates for the use of contrast agents, to enable cost-effective clinical diagnosis. 5. Incorporate effective teamwork strategies for the implementation of contrast agents in the echocardiography laboratory and establish guidelines for contrast use. 6. Use contrast enhancement for endocardial border delineation and left ventricular opacification in rest and stress echocardiography and unique patient care environments in which echocardiographic image acquisition is frequently challenging, including intensive care units (ICUs) and emergency departments. 7. Effectively use contrast echocardiography for the diagnosis of intracardiac and extracardiac abnormalities, including the identification of complications of acute myocardial infarction. 8. Assess the common pitfalls in contrast imaging and use stepwise, guideline-based contrast equipment setup and contrast agent administration techniques to optimize image acquisition.
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10
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Venturini E, Magni L, Franchini C, Testa R. Right atrial hemangioma. J Cardiovasc Med (Hagerstown) 2008; 9:1260-2. [DOI: 10.2459/jcm.0b013e328313e8a4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Alpesh A P, Ebere O C, Daniel S S, Vivek B, Stuart O S, Anastasia A, Aasha S G. A right atrial hemangioma mimicking thrombus in a patient with atrial arrhythmias. Open Cardiovasc Med J 2008; 1:34-5. [PMID: 18949089 PMCID: PMC2570566 DOI: 10.2174/1874192400701010034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Revised: 11/28/2007] [Accepted: 11/30/2007] [Indexed: 11/22/2022] Open
Abstract
Cardiac hemangiomas are rare tumors, accounting for only 2.8% of all benign primary cardiac tumors and occur at any age. Clinical presentations vary depending on the tumor location (myocardial, endocardial or pericardial). In many cases, this may be an incidental finding. We report the case of a patient with paroxysmal atrial fibrillation who had a right atrial hemangioma detected with transesophageal echocardiography prior to having percutaneous pulmonary vein isolation performed.
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Affiliation(s)
- Patel Alpesh A
- Adult Noninvasive Laboratory, St. Francis Hospital, Roslyn, NY, Stony Brook University, Stony Brook, NY, USA
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12
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Kholeif MA, Qubbany AW, Mando MT, Satti MB. Pulmonary Stenosis due to Right Ventricular Outflow Tract Metastasis from a Uterine Sarcoma. Scott Med J 2008. [DOI: 10.1258/rsmsmj.53.3.57g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 50 year-old woman presented with dyspnoea and symptoms and signs of systemic venous congestion. Examination revealed murmur of pulmonary stenosis. Echo-Doppler, CT scanning and Magnetic Resonance Imaging showed a large right ventricular tumour obstructing the right ventricular outflow tract. She had a hysterectomy for menorrhagia 9 years previously, and resection of a lump involving the right trapezius a month prior to her deterioration. Pathology demonstrated low-grade endometrial stromal sarcoma. She deteriorated acutely in hospital due to pulmonary embolism from superimposed thrombosis. Anticoagulation, followed by radiotherapy resulted in marked clinical improvement. Two years later, the patient remains well. Cardiac metastasis from ESS is rare. Diagnosis is established by echocardiography, CT and cardiac MRI, which allow structural and functional evaluation of the tumour. MRI seems to be the most useful modality. Treatment is palliative or curative resection. This is the first case report of cardiac ESS showing good response and prolonged survival after radiotherapy. Prophylactic anticoagulation should be considered as pulmonary embolism can cause marked deterioration.
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Affiliation(s)
- MA. Kholeif
- Departments of Medicine, King Khalid National Guard Hospital at King Abdul-Aziz Medical City, Jeddah, Kingdom of Saudi Arabia
| | - AW. Qubbany
- Departments of Medicine, King Khalid National Guard Hospital at King Abdul-Aziz Medical City, Jeddah, Kingdom of Saudi Arabia
| | - MT. Mando
- Radiology, King Khalid National Guard Hospital at King Abdul-Aziz Medical City, Jeddah, Kingdom of Saudi Arabia
| | - MB. Satti
- Radiology, King Khalid National Guard Hospital at King Abdul-Aziz Medical City, Jeddah, Kingdom of Saudi Arabia
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Nunes MDCP, Barbosa FBL, Gelape CL, Leduc LR, Castro LRA, Gresta LT, Ferrari TCA. Piercing-related endocarditis presenting with multiple large masses in the right-side chamber of the heart. J Am Soc Echocardiogr 2007; 21:776.e1-3. [PMID: 17961978 DOI: 10.1016/j.echo.2007.08.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Indexed: 11/27/2022]
Abstract
We present a case report of a 15-year-old girl with right-side endocarditis, which presented with multiple large masses located on both right chambers mimicking the appearance of a tumor. There were no predisposing factors other than an infected navel piercing. Piercing-associated infective endocarditis has occasionally been reported, and usually occurs in patients with an underlying cardiac condition. We briefly discuss the main features of piercing-related endocarditis and also some aspects of cardiac tumors as differential diagnosis of large cardiac masses.
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Stainback RF, Hamirani YS, Cooley DA, Buja LM. Tumors of the Heart. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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15
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Tallarico D, Chiavari PA, Critelli G, Carbone I, Passariello R. Visualization of right atrial tumor mass with transesophageal echocardiography through nasal way (TEENW). J Am Soc Echocardiogr 2005; 18:69-70. [PMID: 15637492 DOI: 10.1016/j.echo.2004.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Demetrio Tallarico
- Second Division of Cardiology, Institute of the Heart and Great Vessels, University La Sapienza, Rome Italy.
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16
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Diaz Castro O, Bueno H, Nebreda LA. Acute myocardial infarction caused by paradoxical tumorous embolism as a manifestation of hepatocarcinoma. BRITISH HEART JOURNAL 2004; 90:e29. [PMID: 15084577 PMCID: PMC1768223 DOI: 10.1136/hrt.2004.033480] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A 71 year old patient presented with a non-ST segment elevation acute myocardial infarction. The echocardiogram showed several masses attached to the interatrial septum. Several days after admission the patient died. A postmortem examination found a large hepatocarcinoma with intravascular and intracardiac metastases and several myocardial infarctions of different ages. The infarctions had been caused by coronary paradoxical embolisms through a patent foramen ovale and contained neoplastic cells from the liver carcinoma, which had not been diagnosed. The cause of death was a massive pulmonary embolism.
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Affiliation(s)
- O Diaz Castro
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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17
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Foster E, Gerber IL. Masses of the heart: perfusing the “good” from the bad**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 2004; 43:1420-2. [PMID: 15093877 DOI: 10.1016/j.jacc.2004.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kirkpatrick JN, Wong T, Bednarz JE, Spencer KT, Sugeng L, Ward RP, DeCara JM, Weinert L, Krausz T, Lang RM. Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. J Am Coll Cardiol 2004; 43:1412-9. [PMID: 15093876 DOI: 10.1016/j.jacc.2003.09.065] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Revised: 08/26/2003] [Accepted: 09/09/2003] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated the usefulness of echocardiographic contrast perfusion imaging in differentiating cardiac masses. BACKGROUND Two-dimensional echocardiography is the primary diagnostic modality for cardiac masses. However, differentiation between the different types of cardiac masses may be difficult at times. We hypothesized that echocardiographic contrast perfusion imaging would differentiate the neo-vascularization of malignancies from the avascularity of thrombi and the sparse vascularity of stromal tumors. METHODS Sixteen patients with cardiac masses underwent power-modulation imaging after echocardiographic intravenous contrast administration. Pixel intensities in the mass and an adjacent section of myocardium were analyzed visually and by dedicated software. All masses had a pathologic diagnosis or resolved after anticoagulation. In a subset of patients, video-intensity curves of contrast replenishment in the mass and myocardium over time were generated. The post-impulse steady-state pixel intensity (A) and initial rate of contrast replenishment after impulse (beta) were compared with an index of blood vessel area on pathology. RESULTS In seven of 16 patients, contrast enhancement resulted in greater pixel intensity in the mass than in the adjacent myocardium. All of these masses were classified pathologically as malignant (n = 6) or benign and vascular (n = 1). Nine masses demonstrated decreased pixel intensity, compared with the myocardium, and were diagnosed pathologically as myxomas (n = 2) or thrombi (n = 5), or they resolved with anticoagulation (n = 2). For the subset of patients, beta correlated with the vessel area index (r = 0.60). CONCLUSIONS Echocardiographic contrast perfusion imaging aids in the differentiation of cardiac masses. Compared with the adjacent myocardium, malignant and vascular tumors hyper-enhanced, whereas stromal tumors and thrombi hypo-enhanced.
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Affiliation(s)
- James N Kirkpatrick
- Adult Noninvasive Cardiac Imaging Laboratories, Section of Cardiology, University of Chicago, Chicago, Illinois 60637, USA
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Landolsi-Ben Ammou A, Ben Fatma L, Kallel L, Gharbi O, Baâti E, Boughzela E, Kraïem C, Tlili K, Korbi S, Ben Ahmed S. Les sarcomes primitifs du cœur : revue de la littérature, illustrée par 3 cas. Ann Cardiol Angeiol (Paris) 2003; 52:370-4. [PMID: 14752920 DOI: 10.1016/s0003-3928(03)00047-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Primary cardiac sarcoma is a rare tumor with a poor prognosis. We report 3 cases with a review of literature about this disease. There were 2 males and 1 woman. The main symptoms were thoracic pain. The clinical features were various and the thoracic ultra sonography exam allowed the diagnosis in the 3 cases. All patients had surgical remove of their cardiac tumor followed by chemotherapy. All of them died within 13 to 36 months after the diagnosis. Primary cardiac sarcoma has a poor prognosis with a mean survival less than 12 months.
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20
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Hoffmann U, Globits S, Schima W, Loewe C, Puig S, Oberhuber G, Frank H. Usefulness of magnetic resonance imaging of cardiac and paracardiac masses. Am J Cardiol 2003; 92:890-5. [PMID: 14516903 DOI: 10.1016/s0002-9149(03)00911-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In this study, magnetic resonance imaging was compared with histology to evaluate the usefulness of magnetic resonance imaging to distinguish malignant from benign cardiac and paracardiac masses in 55 patients. Tumor location, tissue composition, and pericardial or pleural effusion all were identified as key predictors of lesion type. Observers were accurate in the prediction of lesion type (area under curve 0.88 and 0.92), and there was good interobserver variability (Cohen's kappa = 0.64).
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Affiliation(s)
- Udo Hoffmann
- Department of Radiology, General Hospital and University of Vienna, Vienna, Austria.
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21
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Cosson S, Kevorkian JP, Milliez P, Beaufils P, Cohen A. A rare localization in right-sided endocarditis diagnosed by echocardiography: a case report. Cardiovasc Ultrasound 2003; 1:10. [PMID: 12952545 PMCID: PMC194433 DOI: 10.1186/1476-7120-1-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Accepted: 08/14/2003] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Right-sided endocarditis occurs predominantly in intravenous drug users, patients with pacemakers or central venous lines and with congenital heart diseases. The vast majority of cases involve the tricuspid valve. CASE PRESENTATION A case of a 31-year-old woman with intravenous drug abuse who had a right-sided vegetation attached to the muscular bundle of the right ventricle is presented. Transthoracic echocardiography revealed a vegetation in the right ventricular outflow tract. Transesophageal echocardiography clearly showed that the 1.8 cm vegetation was not adherent to the pulmonary valve but attached to a muscular bundle. CONCLUSIONS Our case points to an unusual location of right-sided endocarditis in intravenous drug users. It confirms that TTE remains an easy and highly sensitive first-line examination for the diagnosis of right-sided endocarditis.
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Affiliation(s)
- Stéphane Cosson
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
| | - Jean-Philippe Kevorkian
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
| | - Paul Milliez
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
| | - Philippe Beaufils
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
| | - Ariel Cohen
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
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22
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Chu MW, Aboguddah A, Kraus PA, Dewar LR. Urgent heart surgery for an atrial mass: metastatic hepatocellular carcinoma. Ann Thorac Surg 2001; 72:931-3. [PMID: 11565692 DOI: 10.1016/s0003-4975(00)02409-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Extension of metastatic hepatocellular carcinoma into the right atrium is exceedingly rare and has a very poor prognosis. We report a case of successful surgical excision of hepatic tumor extension into the right atrium that was causing hemodynamic compromise.
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Affiliation(s)
- M W Chu
- Division of Cardiovascular and Thoracic Surgery, Regina General Hospital, Saskatchewan, Canada
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23
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Willaert W, Claessens P, Vanderheyden M. Leiomyosarcoma of the right ventricle extending into the pulmonary trunk. BRITISH HEART JOURNAL 2001. [DOI: 10.1136/hrt.86.1.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Primary leiomyosarcomas of the heart, particularly those affecting the right ventricle, are uncommon. A 70 year old woman presenting with the symptoms of progressive exertional dyspnoea and left sided pleuritic pain is presented. A leiomyosarcoma was diagnosed that originated in the right lateral ventricle wall, causing pulmonary outflow obstruction. Pathological analysis showed a neoplasm with a myxoid stroma, high mitotic activity, and nuclei expressing atypia. Immunohistochemical staining was found positive for vimentin and desmin. Seven months after complete surgical resection the tumour relapsed. This case illustrates the poor outcome, high relapse rate, and inefficiency of treatment associated with primary cardiac leiomyosarcomas. The current literature regarding incidence, diagnostic techniques, treatment strategies, and survival rates of this rare but terminal disease is reviewed.
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24
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Abstract
Primary leiomyosarcomas of the heart, particularly those affecting the right ventricle, are uncommon. A 70 year old woman presenting with the symptoms of progressive exertional dyspnoea and left sided pleuritic pain is presented. A leiomyosarcoma was diagnosed that originated in the right lateral ventricle wall, causing pulmonary outflow obstruction. Pathological analysis showed a neoplasm with a myxoid stroma, high mitotic activity, and nuclei expressing atypia. Immunohistochemical staining was found positive for vimentin and desmin. Seven months after complete surgical resection the tumour relapsed. This case illustrates the poor outcome, high relapse rate, and inefficiency of treatment associated with primary cardiac leiomyosarcomas. The current literature regarding incidence, diagnostic techniques, treatment strategies, and survival rates of this rare but terminal disease is reviewed.
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Affiliation(s)
- W Willaert
- Department of Cardiology, Imelda Ziekenhuis, Bonheiden, B-2820, Belgium
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25
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Willaert W, Claessens P, Shoja A, Heremans A, Deferm H, Roelandts J, Vanderheyden M. Ventricular outflow tract obstruction secondary to leiomyosarcoma of the right ventricle. JAPANESE HEART JOURNAL 2001; 42:377-86. [PMID: 11605776 DOI: 10.1536/jhj.42.377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Primary leiomyosarcomas of the heart, particularly those affecting the right ventricle, are uncommon. We report the case of a 70-year-old Belgian woman presenting with the symptoms of progressive exertional dyspnea and left-sided pleuritic pain. A leiomyosarcoma which originated from the right lateral ventricle wall, causing pulmonary outflow obstruction, was diagnosed. Pathology revealed a neoplasm with a myxoid stroma, high mitotic activity and nuclei expressing atypia. Immunohistochemical staining was positive for vimentine and desmin. Seven months after complete surgical resection the tumor relapsed. This case demonstrates the poor outcome, the high relapse rate and inefficiency of treatment associated with primary cardiac leiomyosarcomas. The current literature regarding the incidence, diagnostic techniques, treatment strategies and survival rates of this rare but terminal disease is reviewed.
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Affiliation(s)
- W Willaert
- Department of Cardiology, Imelda Ziekenhuis, Bonheiden, Belgium
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26
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Lestuzzi C, Viel E, Mimo R, Meneguzzo N. Left atrial invasion by lung carcinoma through a pulmonary vein. Int J Cardiovasc Imaging 2001; 17:107-10. [PMID: 11558969 DOI: 10.1023/a:1010621320976] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe a rare case of small-cell lung carcinoma invading the left atrium through a pulmonary vein. Echocardiography was particularly useful in this case in assessing the intracavitary extension of the tumor and the outcome of therapy. Echocardiography is a low-cost, easy imaging tool, complementary to radiological techniques and useful in evaluating thoracic tumors involving the cardiovascular structures.
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Affiliation(s)
- C Lestuzzi
- Servizio di Cardiologia, Centro di Riferimento Oncologico-National Cancer Institute, Aviano (PN), Italy.
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27
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Jiménez-Navarro MF, Carlos Gavilán J, María Melero J, Rodríguez Bailón I, Bermúdez F, Porras C, Olalla E, de Teresa E. [Large myxoma of the right atrium]. Rev Esp Cardiol 2001; 54:399-401. [PMID: 11262379 DOI: 10.1016/s0300-8932(01)76320-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the case of a patient in whom two-dimensional echocardiography, performed due to dissociated cholestasis and jugular ingurgitation, demonstrated a huge mass in the right atrium which prolapsed in the right ventricle. Intraoperative transesophageal echocardiography was performed to further assess the dimension and characteristics of the mass and to discard the involvement of associated structures. The patient underwent a cardiopulmonary bypass surgery and the mass (12 * 5 cm) was removed without complications. Histologic examination confirmed the diagnosis of myxoma. This case is of interest because of the size of the mass, and is centered in the diagnosis following clinical suspicion due to the pattern of dissociated cholestasis and jugular ingurgitation leading to surgery to prevent the potential embolic complications.
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Affiliation(s)
- M F Jiménez-Navarro
- Servicio de CardiologíaUnidad de Hepatitis, Servicio de Medicina Interna, Malaga.
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28
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Jurkovich D, de Marchena E, Bilsker M, Fierro-Renoy C, Temple D, Garcia H. Primary cardiac lymphoma diagnosed by percutaneous intracardiac biopsy with combined fluoroscopic and transesophageal echocardiographic imaging. Catheter Cardiovasc Interv 2000; 50:226-33. [PMID: 10842397 DOI: 10.1002/(sici)1522-726x(200006)50:2<226::aid-ccd19>3.0.co;2-a] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Primary cardiac tumors have very low prevalence with cardiac lymphoma, being one of the rarest forms. Several recent reports have shown transesophageal echocardiography to be an accurate technique for characterizing and localizing these neoplasms, with results comparable to CT and MRI scans. Transvenous intracardiac tumor biopsy has been employed as a minimally invasive technique to obtain tissue samples. The addition of transesophageal echocardiographic (TEE) guidance to this process has increased the accuracy of obtaining diagnostic specimens while improving patient safety. We review published cases of this relatively new technique using combined fluoroscopic and TEE guidance and present a case of primary cardiac lymphoma diagnosed by this method. The patient achieved complete tumor remission after treatment with standard chemotherapy and remains fully functional 32 months after initial diagnosis.
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Affiliation(s)
- D Jurkovich
- Division of Cardiology, University of Miami School of Medicine, Miami, Florida 33101, USA
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29
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Mychaskiw G, Gamble HA, Eichhorn JH. Transesophageal echocardiography as an aid to surgical decision-making during resection of a rare thoracic neoplasm. J Cardiothorac Vasc Anesth 1999; 13:588-91. [PMID: 10527230 DOI: 10.1016/s1053-0770(99)90013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- G Mychaskiw
- Department of Anesthesiology, University of Mississippi School of Medicine, Jackson 39216-4505, USA
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30
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31
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Kornberg A, Wildhirt SM, Kreuzer E, Reichart B. Asymptomatic right atrial leiomyosarcoma with tricuspid valve obstruction in a young female patient. Eur J Cardiothorac Surg 1998; 14:635-8. [PMID: 9879879 DOI: 10.1016/s1010-7940(98)00243-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary cardiac leiomyosarcomas of the heart are rare tumors usually diagnosed post-mortem. Like other sarcomas located in the heart, it causes symptoms by obstruction or occlusion of cardiac cavities, local invasion, embolization or by systemic manifestations. We present an unusual case of a previously healthy young female patient who was accidentally diagnosed with a cardiac tumor of unknown origin during routine physical examination in May 1997. Until a few days prior to elective cardiac surgery for diagnostic purposes in June 1997, no clinical symptoms were present. To our surprise, a primary right atrial leiomyosarcoma was found which almost completely occluded the right atrium and destroyed the tricuspid valve. Despite the combination of surgical removal and adjuvant chemotherapy the patient died 3 weeks after the operation due to progressive tumor disease and development of congestive heart failure and lung embolism.
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Affiliation(s)
- A Kornberg
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Klinikum Grosshadern, Germany
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32
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Minardi G, Pulignano G, Sentinelli S, Narducci C, Giovannini M. Left atrial leiomyosarcoma: double occurrence and double recurrence--report of one case. J Am Soc Echocardiogr 1998; 11:1171-6. [PMID: 9924001 DOI: 10.1016/s0894-7317(98)80017-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In October 1996 a 67-year-old man underwent transthoracic and transesophageal echocardiography (TEE) because of dyspnea on exertion and was found to have 2 left atrial cardiac masses. The 2 masses were surgically removed from the atrium and showed histopathologic and ultrastructural features of a leiomyosarcoma. Seven months later a double recurrence of left atrial masses was found with TEE; the patient refused surgery and decided instead to receive chemotherapy. In May 1998 he was in stable condition (New York Heart Association class III), but a further growth of the 2 left atrial masses was observed at TEE. We describe the echocardiographic features of the 2 cardiac masses and the clinical and prognostic implications.
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Affiliation(s)
- G Minardi
- Department of Cardiology, S Camillo Hospital, Rome, Italy
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