1
|
Baltodano-Arellano R, Alvarez-Tiburcio E, Barriales-Revilla L, Bellido-Yarlequé D, Cachicatari A, Cupe-Chacalcaje K, La Torre-Zuñiga A, Velarde-Acosta K. Case report and literature review: cardiac hematic cyst. Front Cardiovasc Med 2024; 11:1417074. [PMID: 39139751 PMCID: PMC11319172 DOI: 10.3389/fcvm.2024.1417074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
A 49-year-old female patient, asymptomatic, presented to the cardiology office for a right atrial mass, identified incidentally in a non-electrocardiogram (ECG)-gated contrast-enhanced computed tomography, performed for follow-up of pulmonary tuberculosis. Echocardiography, surprisingly, showed an anechogenic ovoid mass in the right atrium measuring 40 × 40 mm2, implanted in the interatrial septum without affecting the tricuspid valve. ECG-gated computed tomography angiography (CTA), confirmed the dimensions of the mass, which presented homogeneous content, calcified areas, and a 12-mm pedicle implanted near the ostium of the coronary sinus. Additionally, contrast uptake and infiltration of adjacent structures were ruled out. In the surgical field, an encapsulated mass with blood content was found, which pathology reported as a hematic endocardial cyst (HEC). These are rare cardiac masses, constituting 1.5% of all primary cardiac tumors. It is usually an incidental finding, and its clinical presentation will depend on its dimensions and the intracardiac hemodynamic impact. A highlighting feature is its anechogenic content on ultrasound, however, multimodality imaging allows for making diagnostic assumptions, discerning between primary cardiac tumors, and provides morphological and hemodynamic information useful for therapeutic decision making. The age of the patient, the large size of the HEC, and its location in the interatrial septum make up a completely atypical presentation of this rare disease, which motivated this report.
Collapse
Affiliation(s)
- Roberto Baltodano-Arellano
- Cardiac Imaging Area of Cardiology Service, Hospital Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | | | | | - Angela Cachicatari
- Cardiac Imaging Area of Cardiology Service, Hospital Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
| | - Kelly Cupe-Chacalcaje
- Cardiac Imaging Area of Cardiology Service, Hospital Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
| | - Alan La Torre-Zuñiga
- Pathological Anatomy Service, Hospital Edgardo Rebagliati Martins - EsSalud, Lima, Peru
| | - Kevin Velarde-Acosta
- Clinical Cardiology Service, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru
| |
Collapse
|
2
|
Brunet J, Cook AC, Walsh CL, Cranley J, Tafforeau P, Engel K, Berruyer C, O’Leary EB, Bellier A, Torii R, Werlein C, Jonigk DD, Ackermann M, Dollman K, Lee PD. Multidimensional Analysis of the Adult Human Heart in Health and Disease using Hierarchical Phase-Contrast Tomography (HiP-CT). BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.09.561474. [PMID: 37873359 PMCID: PMC10592740 DOI: 10.1101/2023.10.09.561474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Cardiovascular diseases (CVDs) are a leading cause of death worldwide. Current clinical imaging modalities provide resolution adequate for diagnosis but are unable to provide detail of structural changes in the heart, across length-scales, necessary for understanding underlying pathophysiology of disease. Hierarchical Phase-Contrast Tomography (HiP-CT), using new (4th) generation synchrotron sources, potentially overcomes this limitation, allowing micron resolution imaging of intact adult organs with unprecedented detail. In this proof of principle study (n=2), we show the utility of HiP-CT to image whole adult human hearts ex-vivo: one 'control' without known cardiac disease and one with multiple known cardiopulmonary pathologies. The resulting multiscale imaging was able to demonstrate exemplars of anatomy in each cardiac segment along with novel findings in the cardiac conduction system, from gross (20 um/voxel) to cellular scale (2.2 um/voxel), non-destructively, thereby bridging the gap between macroscopic and microscopic investigations. We propose that the technique represents a significant step in virtual autopsy methods for studying structural heart disease, facilitating research into abnormalities across scales and age-groups. It opens up possibilities for understanding and treating disease; and provides a cardiac 'blueprint' with potential for in-silico simulation, device design, virtual surgical training, and bioengineered heart in the future.
Collapse
Affiliation(s)
- J. Brunet
- Department of Mechanical Engineering, University College London, London, UK
- European Synchrotron Radiation Facility, Grenoble, France
| | - A. C. Cook
- UCL Institute of Cardiovascular Science, London, UK
| | - C. L. Walsh
- Department of Mechanical Engineering, University College London, London, UK
| | - J. Cranley
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - P. Tafforeau
- European Synchrotron Radiation Facility, Grenoble, France
| | - K. Engel
- Siemens Healthineers, Erlangen, Germany
| | - C. Berruyer
- Department of Mechanical Engineering, University College London, London, UK
- European Synchrotron Radiation Facility, Grenoble, France
| | - E. Burke O’Leary
- Department of Mechanical Engineering, University College London, London, UK
| | - A. Bellier
- Laboratoire d’Anatomie des Alpes Françaises (LADAF), Université Grenoble Alpes, Grenoble, F
| | - R. Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - C. Werlein
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Lung Research Centre (DZL), Hannover, Germany
| | - D. D. Jonigk
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Lung Research Centre (DZL), Hannover, Germany
- Institute of Pathology, Aachen Medical University, RWTH Aachen, Germany
| | - M. Ackermann
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - K. Dollman
- European Synchrotron Radiation Facility, Grenoble, France
| | - P. D. Lee
- Department of Mechanical Engineering, University College London, London, UK
- Research Complex at Harwell, Didcot, UK
| |
Collapse
|
3
|
Jolobe O. Wide-ranging clinical spectrum of paradoxical embolism. Postgrad Med J 2021; 98:958-966. [PMID: 34006630 DOI: 10.1136/postgradmedj-2020-139691] [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: 12/29/2020] [Revised: 02/23/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
The purpose of this review is to raise the index of suspicion for paradoxical embolism among generalists. The review is based solely on anecdotal reports compiled from EMBASE, MEDLINE, Googlescholar and Pubmed. Search terms were 'paradoxical embolism', 'pulmonary embolism' and 'pulmonary arteriovenous malformations'. What emerged was that right-to-left paradoxical embolism could occur with or without concurrent pulmonary embolism, and also with and without proof of the presence of an 'embolus-in-transit'. Potential sites of single or multiple systemic involvement included the central nervous system, the coronary circulation, renal arterial circulation, splenic circulation, the mesenteric circulation and the limbs. In many cases, the deep veins of the lower limbs were the source of thromboembolism. In other cases, thrombi originated from an atrial septal aneurysm, from a central venous line, from a haemodialysis-related arterio-venous shunt, from a popliteal vein aneurysm, internal jugular vein, superior vena cava, from a pulmonary arteriovenous malformation, from tricuspid valve endocarditis (with and without pulmonary embolism) and from the right atrium, respectively. Stroke was by far the commonest systemic manifestation of paradoxical embolism. Some strokes were attributable to pulmonary arteriovenous malformations with or without coexistence of intracardiac shunts. Clinicians should have a high index of suspicion for paradoxical embolism because of its time-sensitive dimension when it occurs in the context of involvement of the intracranial circulation, coronary circulation, mesenteric circulation, and peripheral limb circulation.
Collapse
|
4
|
Zoltowska DM, Agrawal Y, Gupta V, Kalavakunta JK. Massive thrombus trapped within an atrial septal defect. BMJ Case Rep 2018; 2018:bcr-2018-225647. [PMID: 29884672 DOI: 10.1136/bcr-2018-225647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Dominika M Zoltowska
- Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
| | - Yashwant Agrawal
- Internal Medicine and Pediatrics, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, Michigan, USA
| | - Vishal Gupta
- Borgess Medical Center, Michigan State University, Kalamazoo, Michigan, USA
| | | |
Collapse
|