1
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Riad M, Rahman MU, Mulyala R, Sayyed N, Bayer D, Omar B. Percutaneous Intracardiac Mass Extraction in High Surgical-Risk Patients. J Med Cases 2023; 14:362-368. [PMID: 38029057 PMCID: PMC10681765 DOI: 10.14740/jmc4150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Large intracardiac masses including tumors, thrombi, and vegetations result in detrimental embolic or obstructive sequelae and present a management dilemma. Open heart surgery, the traditional approach, may not be an option for many patients with a prohibitive surgical risk due to multiple comorbidities. Recently, percutaneous options have emerged with reported success in extracting such intracardiac masses. A 42-year-old female with history of advanced primary sclerosing cholangitis with decompensated liver cirrhosis causing ascites and variceal bleed presented to the emergency department with fatigue, subjective fevers, chills and melena. Laboratory results revealed neutrophil-predominant leukocytosis and normocytic anemia, and blood cultures were positive for Candida albicans. Electrocardiography showed sinus tachycardia. Chest X-ray was unremarkable. She underwent packed red blood cell transfusion and esophageal banding for variceal bleeding. Transthoracic echocardiogram revealed normal left ventricular ejection fraction and no wall motion abnormalities. A right atrial mobile mass measuring approximately 1.0 × 3.0 cm was noted. Multidisciplinary heart team discussion concluded that while the mass posed a high embolic risk, the patient had a prohibitive risk for surgical intervention. Successful percutaneous removal of the mass using Penumbra system device (Penumbra Incorporated, Alameda, CA) was accomplished. This case report details the procedure and outcomes, as well as presents a literature review.
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Affiliation(s)
- Mariam Riad
- Cardiology Division, University of South Alabama, Mobile, AL 36617, USA
| | | | | | - Nadia Sayyed
- Department of Internal Medicine, Khyber Medical College, Peshawar, Pakistan
| | - Danielle Bayer
- Cardiology Division, University of South Alabama, Mobile, AL 36617, USA
| | - Bassam Omar
- Cardiology Division, University of South Alabama, Mobile, AL 36617, USA
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2
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Murukendiran GJ, Babu S, Gadhinglajkar SV, Sreedhar R, Palaniswamy N, Pillai V. Extracardiac Intrapericardial Mass Impersonating as Left Atrial Mass: Echocardiographic Perspectives. A A Pract 2021; 15:e01359. [PMID: 33405398 DOI: 10.1213/xaa.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Extracardiac intrapericardial masses arising posterior to left atrium (LA) often mimic an intracardiac LA mass on echocardiography. Although transthoracic echocardiography (TTE) is the primary screening tool to detect any cardiac mass, transesophageal echocardiography (TEE) is proven superior to TTE in delineating the size, morphology, and exact site of origin of LA masses. We report a case, where the preoperative TTE diagnosed an LA mass which was later confirmed to be an extracardiac intrapericardial mass by cardiac magnetic resonance imaging and intraoperative TEE. The mass was compressing the LA, and the timely diagnosis avoided the opening of the LA for mass excision.
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Affiliation(s)
| | - Saravana Babu
- From the Division of Cardiothoracic and Vascular Anesthesia
| | | | - Rupa Sreedhar
- From the Division of Cardiothoracic and Vascular Anesthesia
| | | | - Vivek Pillai
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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3
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Isaev GO, Mironova OY, Yudakova ME, Shakhnovish RM, Fomin VV. [Metastatic lesion of the right atrium with renal cell carcinoma]. TERAPEVT ARKH 2019; 91:124-128. [PMID: 32598823 DOI: 10.26442/00403660.2019.09.000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Tumors in the heart are rare and difficult to diagnose pathologies. There are primary and secondary tumors, the letter tumors include metastases of other tumors. In this work is presented clinical case of metastatic lesion of the right atrium with renal cell carcinoma. Modern methods of diagnostics of patients with intracardiac formations are discussed.
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Affiliation(s)
- G O Isaev
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O Y Mironova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M E Yudakova
- Hospital of the Central Bank of the Russian Federation
| | | | - V V Fomin
- Sechenov First Moscow State Medical University (Sechenov University)
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4
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Rathi VK, Czajka AT, Thompson DV, Doyle M, Tewatia T, Yamrozik J, Williams RB, Biederman RWW. Can cardiovascular MRI be used to more definitively characterize cardiac masses initially identified using echocardiography? Echocardiography 2018; 35:735-742. [DOI: 10.1111/echo.14017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vikas K. Rathi
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
- Bon Secours Health System; Richmond VA USA
| | - Anna T. Czajka
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
| | | | - Mark Doyle
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
| | - Tarun Tewatia
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
| | - June Yamrozik
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
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5
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Tamura T. Transesophageal Echocardiograms of a Left Atrial Rhabdomyosarcoma. Ann Thorac Surg 2017; 103:e555. [PMID: 28528067 DOI: 10.1016/j.athoracsur.2017.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 12/23/2016] [Accepted: 01/07/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Takahiro Tamura
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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6
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Isobe S. Editorial: Cardiac tumors: Histopathological aspects and assessments with cardiac noninvasive imaging. J Cardiol Cases 2015; 12:37-38. [PMID: 30524535 PMCID: PMC6262153 DOI: 10.1016/j.jccase.2015.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Satoshi Isobe
- Corresponding author at: Department of Cardiology, Isobe Naika Clinic, 3F Nichimaru Nagoya Bldg, 1-3 Shinsakae-machi, Naka-ku, Nagoya 460-0004, Japan. Tel.: +81 52 971 0515; fax: +81 52 971 6829.
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7
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Calissendorff J, Maret E, Sundin A, Falhammar H. Ileal neuroendocrine tumors and heart: not only valvular consequences. Endocrine 2015; 48:743-55. [PMID: 25319177 DOI: 10.1007/s12020-014-0446-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/01/2014] [Indexed: 12/11/2022]
Abstract
Ileal neuroendocrine tumors (NETs) often progress slowly, but because of their generally nonspecific symptoms, they have often metastasized to local lymph nodes and to the liver by the time the patient presents. Biochemically, most of these patients have increased levels of whole blood serotonin, urinary 5-hydroxyindoleacetic acid, and chromogranin A. Imaging work-up generally comprises computed tomography or magnetic resonance imaging and somatostatin receptor scintigraphy, or in recent years positron emission tomography with 68Ga-labeled somatostatin analogs, allowing for detection of even sub-cm lesions. Carcinoid heart disease with affected leaflets, mainly to the right side of the heart, is a well-known complication and patients routinely undergo echocardiography to diagnose and monitor this. Multitasking surgery is currently recognized as first-line treatment for ileal NETs with metastases and carcinoid heart disease. Open heart surgery and valve replacement are advocated in patients with valvular disease and progressive heart failure. When valvulopathy in the tricuspid valve results in right-sided heart failure, a sequential approach, performing valve replacement first before intra-abdominal tumor-reductive procedures are conducted, reduces the risk of bleeding. Metastases to the myocardium from ileal NETs are seen in <1-4.3% of patients, depending partly on the imaging technique used, and are generally discovered in those affected with widespread disease. Systemic treatment with somatostatin analogs, and sometimes alpha interferon, is first-line medical therapy in metastatic disease to relieve hormonal symptoms and stabilize the tumor. This treatment is also indicated when heart metastases are detected, with the addition of diuretics and fluid restriction in cases of heart failure. Myocardial metastases are rarely treated by surgical resection.
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Affiliation(s)
- Jan Calissendorff
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden,
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8
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Calissendorff J, Sundin A, Falhammar H. ⁶⁸Ga-DOTA-TOC-PET/CT detects heart metastases from ileal neuroendocrine tumors. Endocrine 2014; 47:169-76. [PMID: 24272595 DOI: 10.1007/s12020-013-0108-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/29/2013] [Indexed: 12/19/2022]
Abstract
Metastases from ileal neuroendocrine tumors (NETs) to the myocardium are rare and generally seen in patients with widespread metastatic NET disease. The objectives of this investigation were to describe the frequency of intracardiac metastases in ileal NET patients examined by (68)Ga-DOTA-TOC-PET/CT and to describe the cases in detail. All (68)Ga-DOTA-TOC-PET/CT examinations performed at the Karolinska University Hospital since 2010 until April 2012 were reviewed. In all, 128 out of 337 examinations were in patients with ileal NETs. Four patients had seven myocardiac metastases, yielding a frequency of 4.3 % in patients with ileal NETs. One patient had cardiac surgery while three were treated with somatostatin analogs. The cardiac metastases did not affect the patients' activity of daily life. (68)Ga-DOTA-TOC-PET/CT is an established imaging modality in identifying cardiac metastases in ileal NETs. Prospective studies are needed to confirm the true clinical value of (68)Ga-DOTA-TOC-PET/CT in detecting cardiac metastases in both ileal and non-ileal NETs.
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Affiliation(s)
- Jan Calissendorff
- Endocrine Section, VO Internmedicin, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, 118 83, Stockholm, Sweden,
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9
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Tumor cardiaco en un paciente de mediana edad con enfermedad coronaria – una rara asociación. REVISTA COLOMBIANA DE CARDIOLOGÍA 2013. [DOI: 10.1016/s0120-5633(13)70065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Pinder M, CharafEddine A, Parnell AS, DiBardino DJ, Knudson JD. Osteosarcoma with Cardiac Metastasis in a 22-year-old Man: A Case Report and Review of Cardiac Tumors. CONGENIT HEART DIS 2013; 9:E147-52. [DOI: 10.1111/chd.12113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Marco Pinder
- Department of Pediatrics; University of Mississippi Medical Center/Batson Children's Hospital
| | - Ahmad CharafEddine
- Department of Pediatrics; Division of Cardiology; University of Mississippi Medical Center/Batson Children's Hospital
| | - Aimee S. Parnell
- Department of Pediatrics; Division of Cardiology; University of Mississippi Medical Center/Batson Children's Hospital
| | - Daniel J. DiBardino
- Department of Surgery; Division of Congenital Heart Surgery; University of Mississippi Medical Center/Batson Children's Hospital
| | - Jarrod D. Knudson
- Department of Pediatrics; Divisions of Critical Care and Cardiology; University of Mississippi Medical Center/Blair E. Batson Hospital for Children; Jackson Miss USA
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11
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Esposito R, Raia R, De Palma D, Santoro C, Galderisi M. The role of echocardiography in the management of the sources of embolism. Future Cardiol 2012; 8:101-14. [PMID: 22185449 DOI: 10.2217/fca.11.72] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The echocardiographic diagnosis of cardiac thrombi, vegetations and tumors as well as the identification of predisposing conditions such as patent foramen ovale, aortic atherosclerosis and other minor causes (e.g., mitral valve prolapse, mitral and aortic valve calcification) have crucial clinical relevance, affecting the choice of surgery and/or of pharmaceutical therapy in the setting of patients presenting embolism. The echocardiographic assessment helps not only for the retrospective diagnosis of sources of embolism but also for the prevention of events in asymptomatic patients. Echocardiography can also distinguish normal variants and artifacts from cardiac masses and tumors. Echocardiographic characterization/typology of cardiac sources of embolism is currently below par when compared with cardiac MRI, the current gold standard. Nevertheless, echocardiography remains the 'first-line' imaging tool, because of its low cost and the possibility to add easily available, functional and structural information at the patient's bedside.
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Affiliation(s)
- Roberta Esposito
- Laboratory of Echocardiography, Cardioangiology with CCU, Department of Clinical & Experimental Medicine, Federico II University Hospital, Naples, Italy
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12
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Abstract
Cardiac metastasis from epithelial thyroid cancer is a very rare and potentially serious complication. We have identified only 54 reported cases over a 130-year period. Here we review this literature. Cardiac metastases are frequently asymptomatic, but when symptoms develop these tend to be severe and often fatal. The prognosis of cardiac metastases from thyroid cancer is unclear as survival data are often missing or absent in reported cases. However, as many patients died suddenly from cardiac complications, the prognosis seems poor. Of those patients who survived, all underwent surgical intervention. Trans-thoracic echocardiography is the diagnostic modality of choice as it allows dynamic evaluation of intracardiac masses. Metastatic involvement of the heart from thyroid cancer is uncommon. Left untreated this complication seems likely to be fatal. Therefore, in patients with established thyroid malignancy who develop cardiac arrhythmias, new murmurs, or signs of cardiac decompensation, we suggest that cardiac metastases be considered. Echocardiography should be performed in patients with advanced thyroid cancer and cardiac symptoms or signs. If a cardiac metastasis is present, we recommend surgical intervention if possible.
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Affiliation(s)
- Sarah R Catford
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia
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13
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Randhawa K, Ganeshan A, Hoey ET. Magnetic Resonance Imaging of Cardiac Tumors: Part 1, Sequences, Protocols, and Benign Tumors. Curr Probl Diagn Radiol 2011; 40:158-68. [DOI: 10.1067/j.cpradiol.2010.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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George A, Parameswaran A, Nekkanti R, Lurito K, Movahed A. Normal anatomic variants on transthoracic echocardiogram. Echocardiography 2010; 26:1109-17. [PMID: 19840080 DOI: 10.1111/j.1540-8175.2009.01013.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Apart from their existence as medical curiosities, anatomic variants also double as diagnostic dilemmas. In the heart, more than in any other location in the body, misinterpretation of normal anatomic variants as pathologic entities can have a profound impact on treatment decisions and clinical consequences. Echocardiography is an easily accessible tool these days and is used routinely in most cardiac evaluations. Thus it becomes imperative for the echocardiographer to be cognizant of normal anatomic variants. Furthermore, echocardiographic findings should always be evaluated in their proper clinical context and diagnoses should never be entertained in a clinical vacuum. The literature is replete with numerous case reports and vignettes on these fascinating structures but is lacking in a formal review of normal anatomic variants. In this article, we have attempted a systemic review of normal variants, their embryologic origins, echocardiographic characteristics, and common pitfalls encountered in their evaluation.
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Affiliation(s)
- Anil George
- East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA
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15
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Hoey E, Mankad K, Puppala S, Gopalan D, Sivananthan M. MRI and CT appearances of cardiac tumours in adults. Clin Radiol 2009; 64:1214-30. [DOI: 10.1016/j.crad.2009.09.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 09/09/2009] [Accepted: 09/18/2009] [Indexed: 10/20/2022]
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16
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Atypical presentation of acute myeloid leukemia: cardiac myeloid sarcoma. Int J Hematol 2009; 89:693-8. [DOI: 10.1007/s12185-009-0313-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/23/2009] [Accepted: 03/27/2009] [Indexed: 12/11/2022]
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17
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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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18
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Ekmektzoglou KA, Samelis GF, Xanthos T. Heart and tumors: location, metastasis, clinical manifestations, diagnostic approaches and therapeutic considerations. J Cardiovasc Med (Hagerstown) 2008; 9:769-77. [DOI: 10.2459/jcm.0b013e3282f88e49] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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19
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Moustafa SE, Sauvé C, Amyot R. Assessment of a right ventricular metastasis using contrast echocardiography perfusion imaging. ACTA ACUST UNITED AC 2008; 9:326-8. [DOI: 10.1093/ejechocard/jen067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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21
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Guglielmini C, Civitella C, Malatesta D, Palmieri C. Metastatic Pericardial Tumors in a Dog With Equivocal Pericardial Cytological Findings. J Am Anim Hosp Assoc 2007; 43:284-7. [PMID: 17823478 DOI: 10.5326/0430284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A metastatic tumor associated with pericardial effusion was diagnosed in a 6-year-old, female, mixed-breed dog. Echocardiography identified multiple echogenic masses adherent to both visceral and parietal pericardium, while results of pericardial fluid cytology were non-diagnostic. The distribution pattern of the masses is remarkable in that they protruded from both pericardial surfaces, rather than one, and demonstrated an oscillatory motion during the cardiac cycle. Pathological examination confirmed the diagnosis of multiple metastatic tumors of the pericardium, with the primary tumor being an anaplastic gastric adenocarcinoma.
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Affiliation(s)
- Carlo Guglielmini
- Department of Veterinary Clinical Sciences, University of Teramo, Teramo, Italy
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22
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Seebacher G, Binder T, Frank H, Wolner E, Mohl W. Cystic formation of the foramen ovale mimicking a right atrial myxoma. Ann Thorac Surg 2006; 82:2296-8. [PMID: 17126161 DOI: 10.1016/j.athoracsur.2006.04.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 03/14/2006] [Accepted: 04/14/2006] [Indexed: 11/29/2022]
Abstract
A 65-year-old woman presented with shortness of breath, stenocardia, and tachycardia. She underwent several steps of examination. Echocardiography showed a suspicious formation in the right atrium extending into the inferior caval vein. The lesion was suspicious for a myxoma, a thrombus, or a malformation. Intraoperatively this formation presented as a cystic formation connected to the right atrial wall in the area of the foramen secundum and filled with blood and five calcified thrombi. We hypothesize that a slit-like opening in the foramen ovale produced a valve-like mechanism bulging parts of the septum secundum and produced this cystic formation.
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Affiliation(s)
- Gernot Seebacher
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
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23
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Ulusoy RE, Kilicaslan F, Kirilmaz A, Kardesoglu E, Cebeci BS, Dincturk M, Yilmaz AT. Papillary fibroelastoma of mitral papillary chordae in a young patient. Int J Cardiovasc Imaging 2006; 22:601-3. [PMID: 16676137 DOI: 10.1007/s10554-006-9084-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Accepted: 02/01/2006] [Indexed: 11/25/2022]
Abstract
Our case is a 38-year-old man, admitted to Cardiology Department with shortness of breath. Echocardiography yields a hyperechogenic mass localized to papillary muscle with severe mitral regurgitation. Coronary angiography demonstrated radiopacity localized to the papillary muscle. The excision of the mass was consistent with elastic tumor, which was reported as papillary fibroelastoma attached to the papillary chordae of the mitral valve. A 29 no St-Jude bileaflet mechanical valve was implanted to mitral position. Papillary fibroelastoma (PF) can be found in young age and originate from the papillary muscle, which the radiopaque angiographic appearance of the mass supports the diagnosis.
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Affiliation(s)
- Rifat Eralp Ulusoy
- Department of Cardiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey
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24
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Abstract
In contrast to primary cardiac tumors, which are less frequent and mostly benign in nature, the majority of intracardiac tumors are metastatic lesions. Cardiac ultrasound has evolved enormously since its emergence in the 1950s and is presently the modality of choice for imaging space-occupying lesions of the heart; it provides high quality, real-time images that are extremely valuable in the evaluation of cardiac masses. Although transthoracic echocardiography is an excellent initial diagnostic technique to evaluate and diagnose cardiac masses, transesophageal echocardiography provides superior image resolution and better visualization of cardiac masses in patients with suboptimal transthoracic echocardiography studies. Computed tomography and magnetic resonance imaging are additional tools used for cardiac imaging and may provide useful information in addition to that obtained by echocardiography, especially when the images obtained by the latter are suboptimal.
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Affiliation(s)
- Moluk Mirrasouli Ragland
- Department of Medicine, University of North Texas Health Science Campus, 855 Montgomery Road, 4 Floor, Fort Worth, Texas 76107, USA
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25
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Neuman Y, Tolstrup K, Blanche C, Luthringer D, Kobal S, Miyamoto T, Luo H, Siegel RJ. Pseudomyxoma Originating from the Interatrial Septum in a Heart Transplant Patient. J Am Soc Echocardiogr 2005; 18:e1. [PMID: 16003277 DOI: 10.1016/j.echo.2004.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This report describes the echocardiographic diagnosis of an intracardiac mass in a heart transplant patient. The typical morphology of the lesions, its attachment to the interatrial septum, and the absence of a nidus focus for thrombus formation led to the preoperative assumption that it was a myxoma. The mass was successfully excised at the time of operation and the patient had an uneventful recovery. Pathology findings revealed a thrombus. Thus, echocardiography may have limited specificity for the differentiation of intracardiac tumors and thrombus.
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Affiliation(s)
- Yoram Neuman
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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26
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Restrepo CS, Largoza A, Lemos DF, Diethelm L, Koshy P, Castillo P, Gomez R, Moncada R, Pandit M. CT and MR imaging findings of malignant cardiac tumors. Curr Probl Diagn Radiol 2005; 34:1-11. [PMID: 15644858 DOI: 10.1067/j.cpradiol.2004.10.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article reviews CT and MRI features of malignant cardiac and pericardial tumors, most of which originate from the lung, breast, melanoma, leukemia, or lymphoma through lymphatic, hematogenous, transvenous, and direct pathways. Although echocardiography establishes the diagnosis in most cases, CT and MRI provide additional physical, spatial, and functional information that further aids the evaluation of metastases. For instance, CT provides superior resolution for detecting calcification or fat, while MRI with its direct multiplanar ability more completely characterizes the heart, pericardium, mediastinum, and lungs. MRI also helps elucidate the pathophysiological effects of these tumors on cardiac function through gated cine-loop sequences. Beyond tumor characterization, both modalities can help confirm diagnosis through the addition of contrast, which helps distinguish tumor from myocardium, thrombus, and blood flow artifact. Ultimately, MRI best facilitates surgical planning and posttreatment follow-up in large part because of its unparalleled ability to locate and delimit these tumors.
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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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