1
|
Futela P, Shabtaie SA, Woelber TJ, Poddar A, Deshmukh AJ, Kowlgi GN. Mantle Cell Lymphoma With Cardiac Involvement Presenting as Complete Heart Block. JACC Case Rep 2024; 29:102416. [PMID: 39157560 PMCID: PMC11328739 DOI: 10.1016/j.jaccas.2024.102416] [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: 03/18/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 08/20/2024]
Abstract
A 50-year-old woman presented with complete heart block on electrocardiogram. Echocardiogram revealed an intracardiac mass with extensive cardiac involvement. The patient was diagnosed with mantle cell lymphoma, confirmed via lymph node biopsy. Pacemaker implantation and chemotherapy were initiated, with subsequent improvement noted. This showcases an unusual manifestation of intracardiac metastasis with conduction system infiltration.
Collapse
Affiliation(s)
- Pragyat Futela
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel A. Shabtaie
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tiffany J. Woelber
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aastha Poddar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Gurukripa N. Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
2
|
Lal V, Harvey J, Kyranis S. Multimodal Imaging Approach to Atrial Myxoma to Optimize Surgical Management. Cureus 2024; 16:e66719. [PMID: 39262555 PMCID: PMC11390125 DOI: 10.7759/cureus.66719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 09/13/2024] Open
Abstract
Cardiac masses are rare and of the neoplastic group, myxomas are the most common. An elderly male with a background of multiple myeloma and previous autologous stem cell transplant presented with dyspnea and chest heaviness with a subsequent cardiac mass found. Multimodal imaging, including three-dimensional (3D) echocardiography and cardiac magnetic resonance (CMR) imaging, was utilized to guide the diagnostic process, particularly given the differential of a cardiac plasmacytoma in the setting of multiple myeloma. CMR was used to identify characteristic features of the mass and 3D echocardiography highlighted the anatomical relationships of the mass in relation to surrounding structures to complement surgical planning. The different imaging approaches and clinical decision-making were implemented to aid in definitive surgical management.
Collapse
Affiliation(s)
- Vineel Lal
- Internal Medicine, Princess Alexandra Hospital, Brisbane, AUS
| | - James Harvey
- Radiology, Princess Alexandra Hospital, Brisbane, AUS
| | - Stephen Kyranis
- Cardiology, Royal Brisbane and Women's Hospital, Brisbane, AUS
| |
Collapse
|
3
|
Lorca MC, Chen I, Jew G, Furlani AC, Puri S, Haramati LB, Chaturvedi A, Velez MJ, Chaturvedi A. Radiologic-Pathologic Correlation of Cardiac Tumors: Updated 2021 WHO Tumor Classification. Radiographics 2024; 44:e230126. [PMID: 38722782 DOI: 10.1148/rg.230126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Cardiac tumors, although rare, carry high morbidity and mortality rates. They are commonly first identified either at echocardiography or incidentally at thoracoabdominal CT performed for noncardiac indications. Multimodality imaging often helps to determine the cause of these masses. Cardiac tumors comprise a distinct category in the World Health Organization (WHO) classification of tumors. The updated 2021 WHO classification of tumors of the heart incorporates new entities and reclassifies others. In the new classification system, papillary fibroelastoma is recognized as the most common primary cardiac neoplasm. Pseudotumors including thrombi and anatomic variants (eg, crista terminalis, accessory papillary muscles, or coumadin ridge) are the most common intracardiac masses identified at imaging. Cardiac metastases are substantially more common than primary cardiac tumors. Although echocardiography is usually the first examination, cardiac MRI is the modality of choice for the identification and characterization of cardiac masses. Cardiac CT serves as an alternative in patients who cannot tolerate MRI. PET performed with CT or MRI enables metabolic characterization of malignant cardiac masses. Imaging individualized to a particular tumor type and location is crucial for treatment planning. Tumor terminology changes as our understanding of tumor biology and behavior evolves. Familiarity with the updated classification system is important as a guide to radiologic investigation and medical or surgical management. ©RSNA, 2024 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Maria Clara Lorca
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Irene Chen
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Gregory Jew
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Andrea C Furlani
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Savita Puri
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Linda B Haramati
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Apeksha Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Moises J Velez
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| | - Abhishek Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 (M.C.L., G.J., S.P., Apeksha Chaturvedi, Abhishek Chaturvedi); Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, NY (I.C., M.J.V.); Department of Radiology, Montefiore Medical Center, New York, NY (A.C.F.); and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (L.B.H.)
| |
Collapse
|
4
|
Matusik PS, Mikrut K, Bryll A, Podolec M, Popiela TJ, Matusik PT. Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis. Acta Radiol 2024; 65:588-600. [PMID: 38619912 DOI: 10.1177/02841851241242461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.
Collapse
Affiliation(s)
- Patrycja S Matusik
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Mikrut
- Department of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amira Bryll
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
- Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Podolec
- Department of Coronary Artery Disease and Heart Failure, St John Paul II Hospital, Kraków, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz J Popiela
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł T Matusik
- Department of Electrocardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
- Department of Electrocardiology, St John Paul II Hospital, Kraków, Poland
| |
Collapse
|
5
|
Saad EA, Mukherjee T, Gandour G, Fatayerji N, Rammal A, Samuel P, Abdallah N, Ashok T. Cardiac myxomas: causes, presentations, diagnosis, and management. Ir J Med Sci 2024; 193:677-688. [PMID: 37737916 DOI: 10.1007/s11845-023-03531-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5-1 case per million individuals. This review article includes discussions based on existing literature on the role of interleukin interactions in the pathophysiology of cardiac myxoma which can lead to embolic complications, aneurysms, and CNS involvement. The objective of this narrative review was to study the variable clinical presentations of cardiac myxoma, its detection and diagnosis involving multiple modalities like genetic and hematological testing, echocardiography, CT, and MRI, of which transoesophageal echocardiogram shows excellent precision with a 90% to 96% accuracy in diagnosing CM. Individuals with the Carney complex are prone to such neoplasia. Cardiac myxomas are challenging to diagnose due to the ambiguity of their differential with thrombi. Myxomas can also be diagnosed by tumor markers like interleukin-6 and endothelial growth factors. The management of CM includes surgical excision like median sternotomy and robotic minimally invasive surgery. The use of robotic surgery in CM increased from 1.8% in 2012 to 15.1% in 2018. Tumor recurrences are uncommon but can occur due to inadequate surgical resection.
Collapse
Affiliation(s)
- Elio Assaad Saad
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Tishya Mukherjee
- Faculty of Medicine, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Moldova
| | - Georges Gandour
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Nora Fatayerji
- Faculty of Medicine and Medical Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Aya Rammal
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Peter Samuel
- International Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia.
| | - Nicolas Abdallah
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | | |
Collapse
|
6
|
Paolisso P, Bergamaschi L, Angeli F, Belmonte M, Foà A, Canton L, Fedele D, Armillotta M, Sansonetti A, Bodega F, Amicone S, Suma N, Gallinoro E, Attinà D, Niro F, Rucci P, Gherbesi E, Carugo S, Musthaq S, Baggiano A, Pavon AG, Guglielmo M, Conte E, Andreini D, Pontone G, Lovato L, Pizzi C. Cardiac Magnetic Resonance to Predict Cardiac Mass Malignancy: The CMR Mass Score. Circ Cardiovasc Imaging 2024; 17:e016115. [PMID: 38502734 PMCID: PMC10949976 DOI: 10.1161/circimaging.123.016115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/24/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Multimodality imaging is currently suggested for the noninvasive diagnosis of cardiac masses. The identification of cardiac masses' malignant nature is essential to guide proper treatment. We aimed to develop a cardiac magnetic resonance (CMR)-derived model including mass localization, morphology, and tissue characterization to predict malignancy (with histology as gold standard), to compare its accuracy versus the diagnostic echocardiographic mass score, and to evaluate its prognostic ability. METHODS Observational cohort study of 167 consecutive patients undergoing comprehensive echocardiogram and CMR within 1-month time interval for suspected cardiac mass. A definitive diagnosis was achieved by histological examination or, in the case of cardiac thrombi, by histology or radiological resolution after adequate anticoagulation treatment. Logistic regression was performed to assess CMR-derived independent predictors of malignancy, which were included in a predictive model to derive the CMR mass score. Kaplan-Meier curves and Cox regression were used to investigate the prognostic ability of predictors. RESULTS In CMR, mass morphological features (non-left localization, sessile, polylobate, inhomogeneity, infiltration, and pericardial effusion) and mass tissue characterization features (first-pass perfusion and heterogeneity enhancement) were independent predictors of malignancy. The CMR mass score (range, 0-8 and cutoff, ≥5), including sessile appearance, polylobate shape, infiltration, pericardial effusion, first-pass contrast perfusion, and heterogeneity enhancement, showed excellent accuracy in predicting malignancy (areas under the curve, 0.976 [95% CI, 0.96-0.99]), significantly higher than diagnostic echocardiographic mass score (areas under the curve, 0.932; P=0.040). The agreement between the diagnostic echocardiographic mass and CMR mass scores was good (κ=0.66). A CMR mass score of ≥5 predicted a higher risk of all-cause death (P<0.001; hazard ratio, 5.70) at follow-up. CONCLUSIONS A CMR-derived model, including mass morphology and tissue characterization, showed excellent accuracy, superior to echocardiography, in predicting cardiac masses malignancy, with prognostic implications.
Collapse
Affiliation(s)
- Pasquale Paolisso
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, Milan, Italy (P.P., E. Gallinoro, E.C., D.A.)
- Department of Biomedical and Clinical Sciences (P.P., E. Gallinoro, E.C., D.A.), University of Milan, Italy
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Italy (P.P., M.B.)
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Marta Belmonte
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Italy (P.P., M.B.)
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (M.B.)
| | - Alberto Foà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Damiano Fedele
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Emanuele Gallinoro
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, Milan, Italy (P.P., E. Gallinoro, E.C., D.A.)
- Department of Biomedical and Clinical Sciences (P.P., E. Gallinoro, E.C., D.A.), University of Milan, Italy
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy (E. Gherbesi, S.C.)
| | - Domenico Attinà
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, Milan, Italy (P.P., E. Gallinoro, E.C., D.A.)
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Fabio Niro
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum (P.R.), University of Bologna, Italy
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health (E. Gherbesi, S.C., A.B., G.P.), University of Milan, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health (E. Gherbesi, S.C., A.B., G.P.), University of Milan, Italy
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy (E. Gherbesi, S.C.)
| | - Saima Musthaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (S.M., A.B.)
| | - Andrea Baggiano
- Department of Clinical Sciences and Community Health (E. Gherbesi, S.C., A.B., G.P.), University of Milan, Italy
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy (S.M., A.B.)
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (A.G.P.)
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, the Netherlands (M.G.)
| | - Edoardo Conte
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, Milan, Italy (P.P., E. Gallinoro, E.C., D.A.)
- Department of Biomedical and Clinical Sciences (P.P., E. Gallinoro, E.C., D.A.), University of Milan, Italy
| | - Daniele Andreini
- Department of Biomedical and Clinical Sciences (P.P., E. Gallinoro, E.C., D.A.), University of Milan, Italy
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health (E. Gherbesi, S.C., A.B., G.P.), University of Milan, Italy
- Department of Biomedical, Surgical and Dentals Sciences (G.P.), University of Milan, Italy
| | - Luigi Lovato
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Department of Medical and Surgical Sciences, DIMEC (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.)
- Alma Mater Studiorum (L.B., F.A., A.F., L.C., D.F., M.A., A.S., F.B., S.A., N.S., D.A., F.N., L.L., C.P.), University of Bologna, Italy
| |
Collapse
|
7
|
Badge M, Kapoor PM, Thiruselvan T, Francis J. Delineating thrombus versus myxoma: Perioperative 3D transesophageal echocardiography to the rescue! J Clin Imaging Sci 2024; 14:6. [PMID: 38469175 PMCID: PMC10927041 DOI: 10.25259/jcis_136_2023] [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: 12/29/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
Cardiac masses are a significant cause of patient morbidity and mortality by virtue of their symptoms and surgical removal. Preoperative diagnosis of a cardiac mass is usually based on clinical correlation and transthoracic echocardiography findings. Myxomas are the most common benign cardiac tumors, commonly occurring in the left atrium attached to the interatrial septum near the fossa ovalis. Although, at times atypical location and unusual morphology may pose a diagnostic dilemma with 2D echocardiography. 3D echocardiography with its multifaceted advantages, including multiplanar cropping abilities and superior imaging quality can help distinguish between a clot and a myxoma.
Collapse
Affiliation(s)
- Mohanish Badge
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - T. Thiruselvan
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Jijo Francis
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| |
Collapse
|
8
|
Oktaviono YH, Saputra PBT, Arnindita JN, Afgriyuspita LS, Kurniawan RB, Pasahari D, Milla C, Wungu CDK, Susilo H, Multazam CECZ, Alkaff FF. Clinical characteristics and surgical outcomes of cardiac myxoma: A meta-analysis of worldwide experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107940. [PMID: 38219702 DOI: 10.1016/j.ejso.2023.107940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024]
Abstract
Cardiac myxoma is the most common primary cardiac tumor. However, existing literature mainly consists of single-center experiences with limited subjects. This systematic review aimed to provide data on clinical characteristics and surgical outcomes of cardiac myxoma. We performed a thorough literature search on May 23, 2023 on PubMed, ProQuest, ScienceDirect, Scopus, and Web of Science. The inclusion criteria were English full-text, observational studies, and included >20 subjects. From the search, 112 studies with a total of 8150 patients were included in the analysis. The mean age was 51 years (95 % confidence interval [95%CI] = 49.1-52.3), and the majority were females (64.3 % [95 % CI = 62.8-65.8 %]). The most common clinical manifestation was cardiovascular symptoms. Echocardiography can diagnose almost all cases (98.1 % [95 % CI = 95.8-99.6 %]). Cardiac myxoma was mostly prevalent in left atrium (85.3 % [95%CI = 83.3-87 %]) and predominantly with pedunculated morphology (75.6 % [95%CI = 64.1-84.3 %]). Post-tumor excision outcomes were excellent, with an early mortality of 1.27 % (95 % CI = 0.8-1.8 %), late mortality rate of 4.7 (95 % CI = 2.5-7.4) per 1000 person-years, and recurrence rate at 0.5 (95 % CI = 0.0-1.1) per 1000 person-years. Tumor excision is warranted in a timely manner once the cardiac myxoma diagnosis is established.
Collapse
Affiliation(s)
- Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - General Academic Hospital Dr. Soetomo, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - General Academic Hospital Dr. Soetomo, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Jannatin Nisa Arnindita
- Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia; Faculty of Medicine, Universitas Airlangga, Indonesia
| | | | | | - Diar Pasahari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - General Academic Hospital Dr. Soetomo, Surabaya, Indonesia
| | - Clonia Milla
- Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | | | - Firas Farisi Alkaff
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands; Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
| |
Collapse
|
9
|
Feng T, Guo Z, Su H, Zhang F, Zhu H, Wang A, Jiang K, Li B. Progress in the Use of Echocardiography in Patients with Tumors. Rev Cardiovasc Med 2024; 25:22. [PMID: 39077667 PMCID: PMC11262398 DOI: 10.31083/j.rcm2501022] [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: 06/20/2023] [Revised: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 07/31/2024] Open
Abstract
Advances in cancer treatment have increased patient survival rates, shifting clinical focus towards minimizing treatment-related morbidity, including cardiovascular issues. Since echocardiography allows for a comprehensive non-invasive assessment at all cancer stages, it is well suited to monitor cardiovascular disease secondary to oncology treatment. This has earned it significant attention in the study of cardiac tumors and treatment-induced cardiac alterations. Ultrasound methods-ranging from transthoracic and transesophageal echocardiography to ultrasound diagnostic techniques including myocardial strain imaging, myocardial work indices, three-dimensional cardiac imaging-offer a holistic view of both the tumor and its treatment impact cardiac function. Stress echocardiography, myocardial contrast echocardiography, and myocardial acoustic angiography further augment this capability. Together, these echocardiographic techniques provide clinicians with early detection opportunities for cardiac damage, enabling timely interventions. As such, echocardiography continues to be instrumental in monitoring and managing the cardiovascular health of oncology patients, complementing efforts to optimize their overall treatment and survival outcomes.
Collapse
Affiliation(s)
- Tiantian Feng
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), 730000 Lanzhou, Gansu, China
| | - Zhaoxia Guo
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 730000 Lanzhou, Gansu, China
| | - Hongling Su
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 730000 Lanzhou, Gansu, China
| | - Fu Zhang
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 730000 Lanzhou, Gansu, China
| | - Hai Zhu
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 730000 Lanzhou, Gansu, China
| | - Aqian Wang
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 730000 Lanzhou, Gansu, China
| | - Kaiyu Jiang
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 730000 Lanzhou, Gansu, China
| | - Bo Li
- Department of Cardiology, Pulmonary Vascular Disease Center (PVDC), Gansu Provincial Hospital, 730000 Lanzhou, Gansu, China
| |
Collapse
|
10
|
Tagliati C, Fogante M, Palmisano A, Catapano F, Lisi C, Monti L, Lanni G, Cerimele F, Bernardini A, Procaccini L, Argalia G, Esposto Pirani P, Marcucci M, Rebonato A, Cerimele C, Luciano A, Cesarotto M, Belgrano M, Pagnan L, Sarno A, Cova MA, Ventura F, Regnicolo L, Polonara G, Uguccioni L, Quaranta A, Balardi L, Barbarossa A, Stronati G, Guerra F, Chiocchi M, Francone M, Esposito A, Schicchi N. Cardiac Masses and Pseudomasses: An Overview about Diagnostic Imaging and Clinical Background. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:70. [PMID: 38256331 PMCID: PMC10818366 DOI: 10.3390/medicina60010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/09/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information. Moreover, the increasingly performed coronary CT angiography to evaluate non-invasively coronary artery disease leads to a rising number of incidental findings. Therefore, CT and MRI are frequently performed imaging modalities when echocardiography is deemed insufficient to evaluate a lesion. A brief comprehensive overview about diagnostic radiological imaging and the clinical background of cardiac masses and pseudomasses is reported.
Collapse
Affiliation(s)
- Corrado Tagliati
- Radiologia, AST Pesaro Urbino, 61121 Pesaro, Italy; (C.T.); (A.R.)
| | - Marco Fogante
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (G.A.); (P.E.P.)
| | - Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.P.); (A.E.)
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giuseppe Lanni
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Federico Cerimele
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Antonio Bernardini
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Luca Procaccini
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Giulio Argalia
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (G.A.); (P.E.P.)
| | - Paolo Esposto Pirani
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (G.A.); (P.E.P.)
| | - Matteo Marcucci
- U.O.C. di Radiodiagnostica, Ospedale Generale Provinciale di Macerata, 62100 Macerata, Italy;
| | - Alberto Rebonato
- Radiologia, AST Pesaro Urbino, 61121 Pesaro, Italy; (C.T.); (A.R.)
| | - Cecilia Cerimele
- Dipartimento di Biomedicina e Prevenzione, Universiy of Roma Tor Vergata, 00133 Roma, Italy; (C.C.); (A.L.); (M.C.)
| | - Alessandra Luciano
- Dipartimento di Biomedicina e Prevenzione, Universiy of Roma Tor Vergata, 00133 Roma, Italy; (C.C.); (A.L.); (M.C.)
| | - Matteo Cesarotto
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina Ospedale di Cattinara, 34149 Trieste, Italy; (M.C.); (L.P.); (A.S.)
| | - Manuel Belgrano
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.B.); (M.A.C.)
| | - Lorenzo Pagnan
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina Ospedale di Cattinara, 34149 Trieste, Italy; (M.C.); (L.P.); (A.S.)
| | - Alessandro Sarno
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina Ospedale di Cattinara, 34149 Trieste, Italy; (M.C.); (L.P.); (A.S.)
| | - Maria Assunta Cova
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.B.); (M.A.C.)
| | | | - Luana Regnicolo
- Department of Neuroradiology, University Hospital of Marche, 60126 Ancona, Italy;
| | - Gabriele Polonara
- Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, 60126 Ancona, Italy;
| | - Lucia Uguccioni
- Emodinamica e Cardiologia Interventistica, AST Pesaro Urbino, 61121 Pesaro, Italy;
| | - Alessia Quaranta
- Cardiologia, Distretto Sanitario di Civitanova Marche, AST 3, 62012 Civitanova Marche, Italy;
| | - Liliana Balardi
- Health Professions Area, Diagnostic Technical Area, University Hospital of Marche, 60126 Ancona, Italy;
| | - Alessandro Barbarossa
- Cardiology and Arrhythmology Clinic, Department of Cardiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (A.B.); (G.S.); (F.G.)
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, Department of Cardiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (A.B.); (G.S.); (F.G.)
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Department of Cardiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (A.B.); (G.S.); (F.G.)
| | - Marcello Chiocchi
- Dipartimento di Biomedicina e Prevenzione, Universiy of Roma Tor Vergata, 00133 Roma, Italy; (C.C.); (A.L.); (M.C.)
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.P.); (A.E.)
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Nicolò Schicchi
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy;
| |
Collapse
|
11
|
Kharawala A, Chen YY, Christian T, Thachil R. Confounding clinical picture in the diagnosis of left ventricular and valvular masses: a case report. Eur Heart J Case Rep 2023; 7:ytad606. [PMID: 38130862 PMCID: PMC10734628 DOI: 10.1093/ehjcr/ytad606] [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: 05/07/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023]
Abstract
Background Masses in the heart and valves have a broad differential diagnosis including infective and rheumatic causes as well as primary or metastatic tumours. Diagnosis involves delineating the location, shape, and origin of the mass/masses and considering the clinical context. This case outlines the work-up and approach to diagnosing a cardiac mass along with imaging findings of a unique secondary metastatic mass in the left ventricle (LV). Case summary A 69-year-old female with past medical history of metastatic lung cancer treated with radiotherapy and breast cancer treated with mastectomy presented with dyspnoea and fever. Due to concern for infective endocarditis, transthoracic echocardiogram (TTE) was performed revealing 2 cm × 0.72 cm finger-like, echo-lucent, mobile mass, appearing to originate from LV lateral wall, protruding into the LV cavity, along with valvular masses on mitral and tricuspid valves. Initial differential diagnosis included benign pathologies, but due to the clinical suspicion of malignancy, cardiac MRI was performed which revealed a broad-based mass with invasion into the LV lateral wall and delayed gadolinium enhancement, suggestive of metastatic tumour. The patient was given Aspirin to prevent embolization and eventually underwent hospice care. Discussion Atypical appearing cardiac masses can be seen on TTE. Cardiac magnetic resonance imaging (MRI) should be used for definite diagnosis in cases where clinical features do not match the echocardiographic findings.
Collapse
Affiliation(s)
- Amrin Kharawala
- Department of Medicine, NewYork City Health+Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yi-Yun Chen
- Department of Medicine, NewYork City Health+Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Timothy Christian
- Department of Cardiology, NewYork City Health+Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rosy Thachil
- Division of Cardiology, NewYork City Health+Hospitals/Elmhurst, Mount Sinai School of Medicine, Queens, NY, USA
| |
Collapse
|
12
|
Cullom C, Frank S, McCabe MD. Bilateral Atrial Myxoma With Mechanical Disruption of the Mitral Valvular Apparatus. J Cardiothorac Vasc Anesth 2023; 37:2032-2039. [PMID: 37357034 DOI: 10.1053/j.jvca.2023.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Christopher Cullom
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA.
| | - Stephanie Frank
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA
| | - Melissa D McCabe
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA
| |
Collapse
|
13
|
Zubair MH, Jain A. Unraveling the Enigmatic World of Cardiac Tumor Imaging. J Cardiothorac Vasc Anesth 2023; 37:2157-2158. [PMID: 37394387 DOI: 10.1053/j.jvca.2023.06.001] [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] [Received: 05/25/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Affiliation(s)
- M Haseeb Zubair
- Department of Anesthesiology and Perioperative Medicine, Marshfield Clinic Medical Center, Marshfield, WI.
| | - Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia Augusta University, Augusta, GA
| |
Collapse
|
14
|
Hădăreanu DR, Berceanu MC, Stroescu RD, Militaru S, Militaru C, Hădăreanu CD, Raicea VC, Şoşea NI, Boldu EO, Munteanu Mirea OC, Radu RI, Gheonea IA, Botezat MM, Militaru C. Intracardiac mass presenting as acute myocardial infarction. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2023; 64:579-585. [PMID: 38184839 PMCID: PMC10863691 DOI: 10.47162/rjme.64.4.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
Cardiac tumors, although rare, present intricate diagnostic and therapeutic challenges, necessitating timely intervention for optimal patient outcomes. This case report focuses on a 65-year-old woman admitted with chest pain and loss of consciousness, ultimately diagnosed with a left ventricular cardiac myxoma. The patient's presentation mimicked acute coronary syndrome, highlighting the diagnostic complexity associated with cardiac tumors. Advanced imaging modalities, including transthoracic echocardiography, computed tomography, and invasive coronary angiography, played a pivotal role in characterizing the intracardiac mass. Histopathological (HP) examination, utilizing immunohistochemistry, confirmed the tumor as a cardiac myxoma. The patient management involved a multidisciplinary approach, leading to surgical resection of the mass and mitral valve replacement. The case underscores the importance of the HP confirmation in patients with cardiac masses, especially when multimodality cardiac imaging suggests various tumor types, simultaneously emphasizing the need for a comprehensive diagnostic approach that includes advanced imaging and histopathology to ensure an accurate diagnosis and tailored management of cardiac tumors.
Collapse
Affiliation(s)
| | | | | | - Sebastian Militaru
- Department of Cardiology, Clinical Emergency County Hospital, Craiova, Romania
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
- Cardiomed Hospital, Craiova, Romania
| | - Constantin Militaru
- Department of Cardiology, Clinical Emergency County Hospital, Craiova, Romania
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
- Cardiomed Hospital, Craiova, Romania
| | - Călin Dinu Hădăreanu
- Department of Cardiovascular Surgery, Clinical Emergency County Hospital, Craiova, Romania
| | - Victor Cornel Raicea
- Department of Cardiovascular Surgery, Clinical Emergency County Hospital, Craiova, Romania
- Department of Cardiovascular Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Nelu Irinel Şoşea
- Department of Cardiovascular Surgery, Clinical Emergency County Hospital, Craiova, Romania
| | - Elian Octavian Boldu
- Department of Cardiovascular Surgery, Clinical Emergency County Hospital, Craiova, Romania
| | - Oana Cristina Munteanu Mirea
- Department of Cardiology, Clinical Emergency County Hospital, Craiova, Romania
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
| | - Răzvan Ilie Radu
- Department of Interventional Cardiology, Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Ioana Andreea Gheonea
- Department of Medical Imaging, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Cristian Militaru
- Department of Cardiology, Clinical Emergency County Hospital, Craiova, Romania
- Department of Cardiovascular Surgery, Clinical Emergency County Hospital, Craiova, Romania
| |
Collapse
|
15
|
Galzerano D, Eltayeb A, Alamri S, Alamri S, Arbili L, Mohammed S. A Ping Pong Ball in the Left Ventricle. J Cardiothorac Vasc Anesth 2023; 37:2153-2156. [PMID: 37394386 DOI: 10.1053/j.jvca.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Abstract
Diagnosing cardiac masses, especially those related to cardiac tumors, is often challenging in clinical practice. Though myxomas are the most common and well-known benign cardiac tumors, other rare and often-neglected tumors can be difficult to diagnose. In this case report, the authors describe a left ventricular cardiac mass with unique and striking imaging features.
Collapse
Affiliation(s)
- Domenico Galzerano
- The Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Abdalla Eltayeb
- The Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Soaad Alamri
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Sultan Alamri
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lana Arbili
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Shamayel Mohammed
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
16
|
Medina Perez M, Lichtenberger JP, Huppmann AR, Gomez M, Ramirez Suarez KI, Foran A, Vaiyani D, White AM, Biko DM. Cardiac and Pericardial Neoplasms in Children: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e230010. [PMID: 37561644 DOI: 10.1148/rg.230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Primary cardiac and pericardial neoplasms are rare in the pediatric population and can include both benign and malignant lesions. Rhabdomyomas, teratomas, fibromas, and hemangiomas are the most common benign tumors. The most common primary cardiac malignancies are soft-tissue sarcomas, including undifferentiated sarcomas, rhabdomyosarcomas, and fibrosarcomas. However, metastatic lesions are more common than primary cardiac neoplasms. Children with primary cardiac and pericardial tumors may present with nonspecific cardiovascular symptoms, and their clinical presentation may mimic that of more common nonneoplastic cardiac disease. The diagnosis of cardiac tumors has recently been facilitated using noninvasive cardiac imaging. Echocardiography is generally the first-line modality for evaluation. Cardiac MRI and CT are used for tissue characterization and evaluation of tumor size, extension, and physiologic effect. The varied imaging appearances of primary cardiac neoplasms can be explained by their underlying abnormality. Treatment of these lesions varies from conservative management, with spontaneous regression of some lesions such as rhabdomyomas, to surgical resection, particularly in patients with associated heart failure. With adequate imaging techniques and knowledge of the pathologic basis of the neoplasm, it is often possible to differentiate benign from malignant tumors, which can greatly affect adequate and timely treatment. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Mariangeles Medina Perez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - John P Lichtenberger
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Alison R Huppmann
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Mariangela Gomez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Karen I Ramirez Suarez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Ann Foran
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Danish Vaiyani
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Ammie M White
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - David M Biko
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| |
Collapse
|
17
|
Alamri F, Eltayeb A, Hamad A, Alamri S, Alamri S, Kaidali W, Tashkandi L, Arbili L, Pergola V, Al Sergani H. A native mitral valve mass beyond imagination. Monaldi Arch Chest Dis 2023; 94. [PMID: 37551101 DOI: 10.4081/monaldi.2023.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 08/09/2023] Open
Abstract
The authors report a case of a patient with a history of immunoglobulin A nephropathy who, during the admission for pneumonia, had an incidental finding of a huge mitral valve (MV) mass on transthoracic echocardiography. The differential diagnosis was challenging because the clinical scenario raised the suspicion of possible infective endocarditis, and the imaging features were suggestive of a myxoma or vegetation. The patient underwent urgent excision of the mass with MV replacement due to the high risk of embolism. Intraoperative findings were consistent with clots or vegetation. The pathology result of the thrombus was beyond our imagination, and to the best of our knowledge, only one case has been reported. Awareness about native MV thrombosis and its etiologic factors, work-up, and management is key for better medical and surgical management planning because this condition is extremely rare and challenging in the clinical and imaging arenas.
Collapse
Affiliation(s)
- Faisal Alamri
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Abdalla Eltayeb
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Alaa Hamad
- College of Medicine, Alfaisal University, Riyadh.
| | - Soaad Alamri
- College of Medicine, Alfaisal University, Riyadh.
| | - Sultan Alamri
- King Saud bin Abdulaziz University for Health Sciences, Riyadh.
| | | | | | - Lana Arbili
- College of Medicine, Alfaisal University, Riyadh.
| | - Valeria Pergola
- Department of Cardio-Thoraco- Vascular Sciences and Public Health, University of Padua.
| | - Hani Al Sergani
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| |
Collapse
|
18
|
Sahebjam M, Asl Fallah S, Ayati A, Farmanesh M. Papillary Muscle Lipoma in a Teenage Patient With Review of the Literature. CASE (PHILADELPHIA, PA.) 2023; 7:316-320. [PMID: 37614694 PMCID: PMC10442363 DOI: 10.1016/j.case.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
•Cardiac lipoma is exceedingly rare in both adult and pediatric populations. •Only a few cases of papillary muscle lipoma have been reported. •TTE is the first step in detecting a cardiac mass. •CMR contributes to the diagnosis of cardiac lipoma. •There are no specific guidelines for the treatment of papillary muscle lipoma.
Collapse
Affiliation(s)
- Mohammad Sahebjam
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Asl Fallah
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahkameh Farmanesh
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
19
|
Campo-Rivera N, Aguilar-Molina O, Barbosa-Balaguera S. Myxoma Mimic in a Patient With Acute Myeloid Leukemia. Cureus 2023; 15:e43714. [PMID: 37724214 PMCID: PMC10505492 DOI: 10.7759/cureus.43714] [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] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Cardiac masses are rare conditions that, depending on their size and location, can cause several cardiac and systemic symptoms. We describe a case of a 21-year-old male with a history of syphilis, pulmonary tuberculosis, and acute myeloid leukemia (AML), in whom a transthoracic echocardiogram assessment was solicited before the initiation of induction chemotherapy. The study revealed a pedunculated, highly mobile mass in the right atrium that protruded to the right ventricle. Surgical resection was performed. During surgery, tricuspid valve perforation was noted and was associated with severe tricuspid valve regurgitation. Histopathological analysis of the resected mass determined that the lesion was a cardiac thrombus.
Collapse
|
20
|
Salmon C, Khurana S, Cavallazzi R. A 79-Year-Old Woman With Shock. Chest 2023; 164:e15-e17. [PMID: 37423701 DOI: 10.1016/j.chest.2022.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/25/2022] [Accepted: 10/12/2022] [Indexed: 07/11/2023] Open
Affiliation(s)
- Cristina Salmon
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville School of Medicine, Louisville, KY.
| | - Shriya Khurana
- Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, KY
| | - Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville School of Medicine, Louisville, KY
| |
Collapse
|
21
|
Kurmann R, El-Am E, Ahmad A, Abbasi MA, Mazur P, Akiki E, Anand V, Herrmann J, Casanegra AI, Young P, Crestanello J, Bois MC, Maleszewski JJ, Klarich K. Cardiac Masses Discovered by Echocardiogram; What to Do Next? STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100154. [PMID: 37520139 PMCID: PMC10382990 DOI: 10.1016/j.shj.2022.100154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 02/12/2023]
Abstract
Cardiac tumors are rare conditions, typically diagnosed on autopsy, but with the advancement of imaging techniques they are now encountered more frequently in clinical practice. Echocardiography is often the initial method of investigation for cardiac masses and provides a quick and valuable springboard for their characterization. While some cardiac masses can be readily identified by echocardiography alone, several require incorporation of multiple data points to reach diagnostic certainty. Herein, we will provide an overview of the main clinical, diagnostic, and therapeutic characteristics of cardiac masses within the framework of their location.
Collapse
Affiliation(s)
- Reto Kurmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Elias Akiki
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ana I. Casanegra
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Phillip Young
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie C. Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph J. Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kyle Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
22
|
Grazzini G, Pradella S, Rossi A, Basile RP, Ruggieri M, Galli D, Palmisano A, Palumbo P, Esposito A, Miele V. Practical Guide to Interpreting Cardiac Magnetic Resonance in Patients with Cardiac Masses. J Cardiovasc Dev Dis 2023; 10:229. [PMID: 37367394 DOI: 10.3390/jcdd10060229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
It is common for a cardiac mass to be discovered accidentally during an echocardiographic examination. Following the relief of a cardiac mass, being able to evaluate and characterize it using non-invasive imaging methods is critical. Echocardiography, computed tomography (CT), cardiac magnetic resonance imaging (CMR), and positron emission tomography (PET) are the main imaging modalities used to evaluate cardiac masses. Although multimodal imaging often allows for a better assessment, CMR is the best technique for the non-invasive characterization of tissues, as the different MR sequences help in the diagnosis of cardiac masses. This article provides detailed descriptions of each CMR sequence employed in the evaluation of cardiac masses, underlining the potential information it can provide. The description in the individual sequences provides useful guidance to the radiologist in performing the examination.
Collapse
Affiliation(s)
- Giulia Grazzini
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Alice Rossi
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Rocco Pio Basile
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Matteo Ruggieri
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Daniele Galli
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Anna Palmisano
- Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20100 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100 L'Aquila, Italy
| | - Antonio Esposito
- Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20100 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| |
Collapse
|
23
|
Șerban A, Dădârlat-Pop A, Tomoaia R, Trifan C, Molnar A, Manole S, Achim A, Suceveanu M. The Role of Multimodality Imaging in the Diagnosis and Follow-Up of Malignant Primary Cardiac Tumors: Myxofibrosarcoma-A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13101811. [PMID: 37238295 DOI: 10.3390/diagnostics13101811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiac tumors are a very rare but heterogenous group of diseases that may reveal themselves through a variety of nonspecific cardiac symptoms that may pose a challenge to the diagnostic process. Myxofibrosarcoma is a particularly rare type of cardiac tumor that carries a poor prognosis, thus making accurate and timely diagnosis essential. A 61-year-old woman presented with fatigue and shortness of breath during mild exercise, symptoms that have progressively worsened during the previous year. Multimodality imaging consisting of transthoracic and transesophageal echocardiography (TTE and TEE), cardiac magnetic resonance (CMR), cardiac computer tomography (CCT), and fluorodeoxyglucose positron emission computer tomography (18F-FDG PET-CT) was used for the diagnosis and postoperative follow-up of a myxofibrosarcoma.
Collapse
Affiliation(s)
- Adela Șerban
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Alexandra Dădârlat-Pop
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Raluca Tomoaia
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Clinical Rehabilitation Hospital, 46-50 Viilor Street, 400347 Cluj-Napoca, Romania
| | - Cătălin Trifan
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Adrian Molnar
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Simona Manole
- Radiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Alexandru Achim
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Mihai Suceveanu
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| |
Collapse
|
24
|
Moskal P, Kubicz E, Grudzień G, Czerwiński E, Dulski K, Leszczyński B, Niedźwiecki S, Stępień EŁ. Developing a novel positronium biomarker for cardiac myxoma imaging. EJNMMI Phys 2023; 10:22. [PMID: 36959477 PMCID: PMC10036702 DOI: 10.1186/s40658-023-00543-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE Cardiac myxoma (CM), the most common cardiac tumor in adults, accounts for 50-75% of benign cardiac tumors. The diagnosis of CM is often elusive, especially in young stroke survivors and transthoracic echocardiography (TTE) is the initial technique for the differential diagnostics of CM. Less invasive cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are not available for the majority of cardiac patients. Here, a robust imaging approach, ortho-Positronium (o-Ps) imaging, is presented to determine cardiac myxoma extracted from patients undergoing urgent cardiac surgery due to unexpected atrial masses. We aimed to assess if the o-Ps atom, produced copiously in intramolecular voids during the PET imaging, serves as a biomarker for CM diagnosing. METHODS Six perioperative CM and normal (adipose) tissue samples from patients, with primary diagnosis confirmed by the histopathology examination, were examined using positron annihilation lifetime spectroscopy (PALS) and micro-CT. Additionally, cell cultures and confocal microscopy techniques were used to picture cell morphology and origin. RESULTS We observed significant shortening in the mean o-Ps lifetime in tumor with compare to normal tissues: an average value of 1.92(02) ns and 2.72(05) ns for CM and the adipose tissue, respectively. Microscopic differences between tumor samples, confirmed in histopathology examination and micro-CT, did not influenced the major positronium imaging results. CONCLUSIONS Our findings, combined with o-Ps lifetime analysis, revealed the novel emerging positronium imaging marker (o-PS) for cardiovascular imaging. This method opens the new perspective to facilitate the quantitative in vivo assessment of intracardiac masses on a molecular (nanoscale) level.
Collapse
Affiliation(s)
- Paweł Moskal
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland.
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland.
- Center for Theranostics, Jagiellonian University, Kraków, Poland.
| | - Ewelina Kubicz
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland.
- Center for Theranostics, Jagiellonian University, Kraków, Poland.
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland.
| | - Grzegorz Grudzień
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Eryk Czerwiński
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland
| | - Kamil Dulski
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland
| | - Bartosz Leszczyński
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
| | - Szymon Niedźwiecki
- Department of Experimental Particle Physics and Applications, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland
| | - Ewa Ł Stępień
- Total-Body Jagiellonian-PET Laboratory, Jagiellonian University, Kraków, Poland.
- Center for Theranostics, Jagiellonian University, Kraków, Poland.
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland.
| |
Collapse
|
25
|
Saputra PBT, Jannah AR, Rofananda IF, Al-Farabi MJ, Wungu CDK, Susilo H, Alsagaff MY, Gusnanto A, Oktaviono YH. Clinical characteristics, management, and outcomes of pulmonary valve myxoma: systematic review of published case reports. World J Surg Oncol 2023; 21:99. [PMID: 36941612 PMCID: PMC10026419 DOI: 10.1186/s12957-023-02984-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Cardiac myxoma is the most common type of primary cardiac tumor, with the majority located in the atrial wall. The tumor is attached to valvular structures in a few cases, of which the pulmonary valve is the least affected. Pulmonary valve myxoma may have different clinical manifestations from the more common cardiac myxomas because of its vital position. A misdiagnosis of these types of cardiac myxoma may be detrimental to the care and well-being of patients. Therefore, this systematic review aims to define the clinical characteristics of pulmonary valve myxoma and how this differs from a more common cardiac myxoma. METHODS Employed literature was obtained from PubMed, ScienceDirect, Scopus, Springer, and ProQuest without a publication year limit on August 23, 2022. The keyword was "pulmonary valve myxoma." Inclusion criteria were as follows: (1) case report or series, (2) available individual patient data, and (3) myxoma that is attached to pulmonary valve structures with no evidence of metastasis. Non-English language or nonhuman subject studies were excluded. Johanna Briggs Institute checklists were used for the risk of bias assessment. Data are presented descriptively. RESULTS This review included 9 case reports from 2237 articles. All cases show a low risk of bias. Pulmonary valve myxoma is dominated by males (5:4), and the patient's median age is 57 years with a bimodal distribution in pediatric and geriatric populations. The clinical manifestation of pulmonary valve myxoma is often unspecified or asymptomatic. However, systolic murmur in the pulmonary valve area is heard in 67% of cases. Echocardiography remains the diagnostic modality of choice in the majority of cases. Tumor attached to the pulmonary cusps or annulus and extended to adjacent tissues in all cases. Therefore, valve replacement or adjacent tissue reconstructions are required in 77% of cases. The recurrence and mortality are considerably high, with 33% and 22% cases, respectively. CONCLUSIONS Pulmonary valve myxoma is more common in males with a bimodal age distribution, and its outcomes seem worse than usual cardiac myxomas. Increasing awareness of its clinical symptoms, early diagnosis, and complete myxoma resection before the presence of congestive heart failure symptoms are important in achieving excellent outcomes. A firm embolization blockade is needed to prevent myxoma recurrence.
Collapse
Affiliation(s)
- Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | | | - Makhyan Jibril Al-Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
- Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya, Indonesia.
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya, Indonesia
| | | | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| |
Collapse
|
26
|
Sykora D, Chaliki HP, Cummings KW, Sell-Dottin K, Stanton ML, Scott LR. Incidentally Discovered Right Atrial Mass: A Rare and Unexpected Etiology. Tex Heart Inst J 2023; 50:492268. [PMID: 37060553 PMCID: PMC10178659 DOI: 10.14503/thij-21-7735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Primary cardiac sarcoma is a rare type of intracardiac mass. This report describes a patient with atrial flutter who had a new right atrial mass incidentally discovered on transesophageal echocardiography. A thrombus was suspected based on radiographic appearance, but there was minimal change with anticoagulation. The mass was resected and found to be an undifferentiated pleomorphic cardiac sarcoma, an uncommon sub-type within the already rare category of primary cardiac neoplasms. This report highlights the importance of considering primary malignancy and thoroughly correlating radiographic and clinical evidence during the diagnostic workup of patients with intracardiac masses.
Collapse
Affiliation(s)
- Daniel Sykora
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Hari P Chaliki
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Kristen Sell-Dottin
- Department of Cardiovascular Surgery, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Melissa L Stanton
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Luis R Scott
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
| |
Collapse
|
27
|
Kesieme EB, Buchan KG. Multiple Right Ventricular Haemangiomas. Cureus 2023; 15:e36570. [PMID: 37095811 PMCID: PMC10122193 DOI: 10.7759/cureus.36570] [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] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Right ventricular haemangiomas are rare benign tumours, usually solitary and commonly located in the right heart. We report a 49-year-old female who presented with four masses in the right ventricle, three arising from the right ventricular free wall and one arising from the anterior leaflet of the tricuspid valve. She subsequently underwent total excision of the tumours and an anteroinferior commissuroplasty for severe tricuspid regurgitation complicating the excision. Histology confirmed cavernous haemangioma. Solitary haemangioma of the right ventricle has been reported severally in the literature but, to the best of our knowledge, this is the first report of multiple right ventricular haemangiomas.
Collapse
Affiliation(s)
- Emeka B Kesieme
- Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, GBR
| | - Keith G Buchan
- Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, GBR
| |
Collapse
|
28
|
Paolisso P, Foà A, Bergamaschi L, Graziosi M, Rinaldi A, Magnani I, Angeli F, Stefanizzi A, Armillotta M, Sansonetti A, Fabrizio M, Amicone S, Impellizzeri A, Tattilo FP, Suma N, Bodega F, Canton L, Gherbesi E, Tuttolomondo D, Caldarera I, Maietti E, Carugo S, Gaibazzi N, Rucci P, Biagini E, Galiè N, Pizzi C. Echocardiographic Markers in the Diagnosis of Cardiac Masses. J Am Soc Echocardiogr 2023; 36:464-473.e2. [PMID: 36610495 DOI: 10.1016/j.echo.2022.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The echocardiographic parameters required for a comprehensive assessment of cardiac masses (CMs) are still largely unknown. The aim of this study was to identify and integrate the echocardiographic features of CMs that can accurately predict malignancy. METHODS An observational cohort study was conducted among 286 consecutive patients who underwent standard echocardiographic assessment for suspected CM at Bologna University Hospital between 2004 and 2022. A definitive diagnosis was achieved by histologic examination or, in the case of cardiac thrombi, with radiologic evidence of thrombus resolution after appropriate anticoagulant treatment. Logistic and multivariable regression analysis was performed to confirm the ability of six echocardiographic parameters to discriminate malignant from benign masses. The unweighted count of these parameters was used as a numeric score, ranging from 0 to 6, with a cutoff of ≥3 balancing sensitivity and specificity with respect to the histologic diagnosis of malignancy. Classification tree analysis was used to determine the ability of echocardiographic parameters to discriminate subgroups of patients with differential risk for malignancy. RESULTS Benign masses were more frequently pedunculated, mobile, and adherent to the interatrial septum (P < .001). Malignant masses showed a greater diameter and exhibited a higher frequency of irregular margins, an inhomogeneous appearance, sessile implantation, polylobate shape, and pericardial effusion (P < .001). Infiltration, moderate to severe pericardial effusion, nonleft localization, sessile implantation, polylobate shape, and inhomogeneity were confirmed to be independent predictors of malignancy in both univariate and multivariable models. The predictive ability of the unweighted score of ≥3 was very high (>0.90) and similar to that of the previously published weighted score. Classification tree analysis generated an algorithm in which infiltration was the best discriminator of malignancy, followed by nonleft localization and sessile implantation. The percentage correctly classified by classification tree analysis as malignant was 87.5%. Agreement between observer readings and CM histology ranged between 85.1% and 91.5%. The presence of at least three echocardiographic parameters was associated with lower survival. CONCLUSIONS In the approach to CMs, some echocardiographic parameters can serve as markers to accurately predict malignancy, thereby informing the need for second-level investigations and minimizing the diagnostic delay in such a complex clinical scenario.
Collapse
Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Alberto Foà
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Luca Bergamaschi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Maddalena Graziosi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Andrea Rinaldi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Ilenia Magnani
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Francesco Angeli
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Andrea Stefanizzi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Matteo Armillotta
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Angelo Sansonetti
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Michele Fabrizio
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Sara Amicone
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Andrea Impellizzeri
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Francesco Pio Tattilo
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Nicole Suma
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Francesca Bodega
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Lisa Canton
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Elisa Gherbesi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | | | - Ilaria Caldarera
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Elisa Maietti
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | | | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elena Biagini
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Nazzareno Galiè
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Carmine Pizzi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy.
| |
Collapse
|
29
|
Grgat D, Dilber D, Hrabak Paar M. Common benign primary pediatric cardiac tumors: a primer for radiologists. Jpn J Radiol 2022; 41:477-487. [PMID: 36495370 DOI: 10.1007/s11604-022-01371-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Cardiac tumors are neoplasms arising from or located in the heart or the pericardium. Although rare, primary cardiac tumors in children require an accurate and timely diagnosis. Most pediatric primary cardiac tumors are benign (around 90%). Echocardiography is the first imaging modality used due to its availability, noninvasiveness, inexpensiveness, and absence of ionizing radiation. Computed tomography (CT) and magnetic resonance imaging (MRI) offer better soft tissue visualization as well as better visualization of extracardiac structures. A great advantage of MRI is the possibility of measuring cardiac function and blood flow, which can be important for obstructing cardiac tumors. In this article, we will offer a brief review of clinical, echocardiographic, CT, and MRI features of cardiac rhabdomyomas, fibromas, teratomas, and lipomas providing their differential diagnosis.
Collapse
Affiliation(s)
- Dora Grgat
- Institute for Emergency Medicine of Zagreb County, Velika Gorica, Croatia
| | - Daniel Dilber
- School of Medicine, Department of Pediatrics, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Maja Hrabak Paar
- School of Medicine, Department of Diagnostic and Interventional Radiology, University of Zagreb, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| |
Collapse
|
30
|
Multimodality Imaging of Benign Primary Cardiac Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102543. [PMID: 36292232 PMCID: PMC9601182 DOI: 10.3390/diagnostics12102543] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.
Collapse
|
31
|
Gaisendrees C, Gerfer S, Schröder C, Schlachtenberger G, Walter S, Ivanov B, Eghbalzadeh K, Lühr M, Djordjevic I, Rahmanian P, Mader N, Kuhn-Régnier F, Wahlers T. Benign and malignant cardiac masses: long-term outcomes after surgical resection. Expert Rev Anticancer Ther 2022; 22:1153-1158. [PMID: 35997214 DOI: 10.1080/14737140.2022.2116006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cardiac tumors represent a rare and heterogenous pathologic entity, with a cumulative incidence of up to 0.02%. This study aimed to investigate one of the largest patient cohorts published for clinical presentation and long-term outcomes after surgical resection. RESEARCH DESIGN Between 2009 and 2021, 183 consecutive patients underwent surgery for tumor excision in our center. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. The diagnosis was confirmed postoperatively by histology and Immunohistochemical investigations. Kaplan-Meier curves assessed survival, and the Cox, proportional hazards model, was used to identify prognostic factors for overall survival. RESULTS This series included 183 consecutive patients; most (n=169, 92.3%) were diagnosed with benign cardiac masses. The mean age of patients was 60 ± 16 years, and 48% (n=88) were females. The largest group of tumors is represented by myxoma (n = 98; 54%). The most common malignant tumor was sarcomas (n = 5; 2.7%). The mean hospital stay was 11 ± 6.5 days, and all-cause mortality after ten years was 14%. CONCLUSION Surgery represents the gold standard in treating primary cardiac tumors; in benign tumors, it is highly effective and curative, whereas, in malignant tumors, it remains associated with more prolonged survival.
Collapse
Affiliation(s)
- Christopher Gaisendrees
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Stephen Gerfer
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Charlotte Schröder
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Georg Schlachtenberger
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Sebastian Walter
- University Hospital Cologne, Department of Orthopaedics, Cologne, Germany
| | - Borko Ivanov
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Kaveh Eghbalzadeh
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Maximilian Lühr
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ilija Djordjevic
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Parwis Rahmanian
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Navid Mader
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Thorsten Wahlers
- University Hospital Cologne, Heart Centre, Department of Cardiothoracic Surgery, Cologne, Germany
| |
Collapse
|
32
|
Ezzeddine FM, Haq IU, Pessanha BS, Pislaru SV, Bois MC, Kummer T, Stanich JA. Point-of-Care Ultrasound Diagnosis of a Giant Left Atrial Mass. CASE 2022; 6:243-246. [PMID: 36036056 PMCID: PMC9399556 DOI: 10.1016/j.case.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiac myxomas can cause cardiac, embolic, and/or constitutional symptoms. POCUS augments emergency care and assists in clinical decision-making. Multimodality imaging can help discern CMs from thrombi and other tumors.
Collapse
|
33
|
Yin H, Mao W, Tan H, Zhu N, Wan Q, Shi J, Qiu L, Xiu Y, Luo R, Yu H, Shi H. Role of 18F-FDG PET/CT imaging in cardiac and pericardial masses. J Nucl Cardiol 2022; 29:1293-1303. [PMID: 33462788 DOI: 10.1007/s12350-020-02510-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/21/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Considering the few reported cardiac masses, PET/CT in the imaging workup of cardiac masses is not well established. This retrospective study analyzed the role of 18F-FDG PET/CT imaging in cardiac/pericardial masses. METHODS AND RESULTS Fifty-nine patients with newly diagnosed cardiac/pericardial masses who underwent PET/CT and transthoracic echocardiography (TTE) were recruited. Echocardiographic and PET/CT characteristics were evaluated for predictive value in differentiating malignant and non-malignant lesions using histologic confirmation as the gold standard. The McNemar test was used to test the differences in sensitivity between PET/CT and TTE. 18F-FDG PET/CT had higher sensitivity in determining the malignancy of cardiac/pericardial masses compared to TTE (sensitivity, 96.6% vs 72.4%, P = .039). However, when pericardial masses were excluded from the analysis, the difference in sensitivity between the two was not statistically significant (sensitivity, 95.6% vs 78.3%, P = .219). 18F-FDG PET/CT identified two malignant pericardial masses missed on TTE, changed the diagnostic orientation of TTE in 15 patients, and found seven patients with extracardiac lesions in 29 malignant patients. CONCLUSIONS PET/CT was an effective additional image modality in patients with suspected malignant cardiac mass for further confirmation and to screen for potential metastasis.
Collapse
Affiliation(s)
- Hongyan Yin
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Wujian Mao
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Hui Tan
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Na Zhu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quan Wan
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Shi
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Qiu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Yan Xiu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haojun Yu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
| |
Collapse
|
34
|
Lahmidi I, Assoweh CD, Haddiya I, Bentata Y, Ouafi NE, Ismaili N. Clinicopathological features of adult right-sided cardiac masses: Analysis of 19 cases. Ann Med Surg (Lond) 2022; 77:103613. [PMID: 35638074 PMCID: PMC9142628 DOI: 10.1016/j.amsu.2022.103613] [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: 02/16/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Right sided cardiac masses are rare. The purpose of this study is to review the clinical experience and pathological characteristics of right-sided cardiac masses and to provide a prognostic analysis in our hospital. Methods We retrospectively reviewed 19 consecutive cases of right heart masses diagnosed in our institution from 2016 to February 2020. All available clinicopathological features, imaging characteristics and disease outcomes were summarized and presented. Results The subjects included 9 men and 10 women with a mean age of 48.5 years. The most frequent complaint was dyspnea. The most common site was the right atrium (42.1%) followed by the tricuspid valve (36.8%). Clinical diagnosis revealed vegetations in 8 patients (42.1%), thrombi in 7 patients (36.8%), myxoma in 1 patient, hydatid cyst in 1 patient and metastatic (secondary) masse was seen in 2 cases. In the 19 patients, 3 patients underwent surgery, 15 patients were managed with medical treatment, therapeutic abstention was indicated in one patient. 14 patients were all alive at the end of the follow-up period. In contrast, 5 patients were dead (26.3%). Conclusion In our series, the majority of right cardiac masses were benign, outnumbering the malignant ones, as described in the literature. The mortality rate was relatively high about 26.3%.
Collapse
Affiliation(s)
- I Lahmidi
- Department of Cardiology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - C Darar Assoweh
- Department of Cardiology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - I Haddiya
- Department of Nephrology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - Y Bentata
- Department of Nephrology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - N El Ouafi
- Department of Cardiology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| | - N Ismaili
- Department of Cardiology, Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed the First, Oujda, Morocco
| |
Collapse
|
35
|
Adeniyi A, Abadir S, Parikh K, Khanna R, Yusuf S, Anais Hichard M. Atypical Intracavitary Cardiac Mass: Tumor or Thrombus? Cureus 2022; 14:e21937. [PMID: 35273878 PMCID: PMC8900971 DOI: 10.7759/cureus.21937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/18/2022] Open
Abstract
Cardiac masses are a rare finding, with most masses found being thrombi or vegetations. Still, some masses are suspected to be a tumor based on multiple characteristics such as size, location, mobility, and the tumor's hemodynamic effects. Cardiovascular magnetic resonance (CMR) and CT have been shown to differentiate a tumor from a thrombus based on tissue characteristics of the mass. Here we highlight the role of contrast perfusion imaging on echocardiography in identifying the malignant potential of a cardiac mass. This case report demonstrates the effectiveness of contrast imaging with a transesophageal echocardiogram in identifying the etiology of cardiac masses without the need of CMR or cardiac CT, which helps save between $100-1207 of hospital costs. Besides the cost-benefit, the use of non-invasive and easily accessible imaging like echocardiogram enables smaller facilities with limited resources to diagnose and hence further manage patients with cardiac masses.
Collapse
|
36
|
Redzek A, Preveden A, Kaloci SR, Samardzija G, Preveden M, Golubovic M, Velicki L. Unusual non-valvular left ventricular endocarditis presenting as multiple brain embolism. Acta Clin Belg 2022; 77:142-146. [PMID: 32602786 DOI: 10.1080/17843286.2020.1789273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Masses inside the heart can cause serious and life-threatening effects to the cardiovascular system, mainly because of hemodynamic obstruction of the blood flow, either in the heart cavities themselves or remotely due to embolization. In this paper, we report a case of left ventricular tumor mass which presented with neurological symptoms due to multiple brain embolism. CASE REPORT A 35-year-old female patient presented with right hemiparesis and dysarthria. Seven days prior to admission she had elevated body temperature and started taking antibiotics. Inflammatory markers were not elevated, and blood cultures were negative. Computerized tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed multiple acute ischemic lesions. Echocardiography showed the presence of a lobular mass inside the left ventricle, which was attached to the basal segment of the lateral left ventricular wall. Based on the laboratory results and additional heart imaging (CT and MRI) the mass was primarily suspected to be a tumor. It was surgically removed. Microscopic analysis of the removed tissue revealed a non-specific endocardial inflammation with formed fresh fibrin thrombi on the surface. During the postoperative recovery intense physical rehabilitation was being performed, so the initial neurological deficit was completely withdrawn. CONCLUSION Intracardiac masses can cause serious and potentially fatal complications that often present with dramatic clinical symptoms. Despite the comprehensive clinical, laboratory, and imaging investigations, intracardiac masses can be hard to distinguish until the definite microscopic analysis. However, with the right approach and multidisciplinary collaboration, they can be successfully managed.
Collapse
Affiliation(s)
- Aleksandar Redzek
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Andrej Preveden
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Svetlana Ruzicka Kaloci
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Golub Samardzija
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Mihaela Preveden
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Miodrag Golubovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Cardiovascular Surgery, Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| |
Collapse
|
37
|
Ma H, Niu Y, Tian M, Liu L, Gong W, Zheng M. A study of 399 cardiac tumors: Characteristics of echocardiography and pathological features. Echocardiography 2021; 39:37-45. [PMID: 34913194 DOI: 10.1111/echo.15249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/21/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS This study aimed to summarize the transthoracic echocardiography (TTE) characteristics of cardiac tumors with different pathologies. METHODS The data of 399 patients with cardiac tumors confirmed by pathology, who had undergone surgical resection were consecutively collected in our hospital between January 1, 2011 and December 31, 2019. The TTE characteristics were summarized and compared with the pathology. RESULTS Mean patient age was 49.8±15.7 years (22 children and 377 adults), and 62.2% were female. Of the tumors, 90.5% (361) were primary and 9.5% (38) were secondary. Further, 88.7% (354) were benign and 11.3% (45) were malignant. Of the primary tumors (96.1% benign and 3.9% malignant), 84.2% were myxomas, followed by 3.5% lipomas and 1.5% fibromas in adults, while in children, 31.8% were rhabdomyomas and 22.7% were fibromas. The most common type of secondary cardiac tumor was malignant liver carcinoma metastasis (39.5%) and benign intravenous leiomyomatosis with cardiac extension from the uterus (18.4%). TTE features of myxoma showed four variation types among 8.9% of myxomas: liquefaction (anechoic region mostly), calcification (hyperechoic range with a shadow), multiple nodules, and high proliferative activity (a large irregular mass with a wide base and a high Ki67 index). The TTE characteristics of some common benign non-myxoma tumors had specific findings. The TTE features of malignant tumors mostly showed hypoechogenicity, an unclear boundary, a wide basement, and multi-chambers or tissue invasion. CONCLUSIONS Most cardiac tumors have typical ultrasonic manifestations. Preoperative echocardiography could roughly judge cardiac tumor type and may be helpful for guiding clinical treatment decisions.
Collapse
Affiliation(s)
- Hui Ma
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yicui Niu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Mingjun Tian
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lu Liu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Wenqing Gong
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Minjuan Zheng
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| |
Collapse
|
38
|
Standridge M, Gaucher J, Burgin CM. Vascular Atypia in a Cardiac Myxoma Patient. Cureus 2021; 13:e18646. [PMID: 34786241 PMCID: PMC8577957 DOI: 10.7759/cureus.18646] [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] [Accepted: 10/10/2021] [Indexed: 11/21/2022] Open
Abstract
Cardiac masses can manifest as a variety of signs and symptoms in adults. In this report, we report a case that highlights the value of advanced imaging of a newly symptomatic and previously undiagnosed cardiac neoplasm. In addition to the standard transthoracic and transesophageal echocardiography, cardiac catheterization may be employed to further understand the vascularity of such cardiac pathology prior to surgical intervention.
Collapse
Affiliation(s)
- Meaghan Standridge
- Department of Surgery, University of Tennessee Medical Center, Knoxville, USA
| | - Jay Gaucher
- Department of Medicine, Prisma Health, Greenville, USA
| | - Chelsea M Burgin
- Department of Emergency Medicine, Prisma Health, University of South Carolina School of Medicine, Greenville, USA
| |
Collapse
|
39
|
Șulea CM, Lakatos B, Kovács A, Benke K, Suhai FI, Csulak E, Merkel E, Nagy B, Hartyánszky I, Merkely B, Szabolcs Z, Pólos M. Blood-filled cyst of the tricuspid valve: Multiple cardiac disorders, one surgical case. J Card Surg 2021; 37:245-248. [PMID: 34713934 DOI: 10.1111/jocs.16108] [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: 09/22/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intracardiac blood cysts are an exceedingly rare occurrence in adulthood. Detailed imaging modalities aid in the diagnosis of such incidental lesions and procedure planning. METHODS We report the case of a 51-year-old male accusing dyspnea on exertion as a sole symptom which led to the discovery of multiple cardiac anomalies, namely, severe aortic valve insufficiency on a bicuspid aortic valve, ascending aortic aneurysm, a cystic mass on the tricuspid valve, patent foramen ovale, and an occluded right coronary artery. RESULTS The disorders were managed in a single surgical intervention, the resected mass being confirmed as a blood cyst. CONCLUSIONS Our case presents a unique association of cardiac disorders, including a highly uncommon intracardiac blood-filled cyst, and underlines the importance of multimodality imaging and interdisciplinary approach in the successful management of such complex cases.
Collapse
Affiliation(s)
- Cristina M Șulea
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ferenc I Suhai
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Eperke Merkel
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Beáta Nagy
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
40
|
Fung XJN, Ng WM, Lee WF. Man with right atrial mass. J Am Coll Emerg Physicians Open 2021; 2:e12568. [PMID: 34604838 PMCID: PMC8476101 DOI: 10.1002/emp2.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Wei Ming Ng
- Department of Emergency MedicineNg Teng Fong General HospitalSingapore
| | - Wei Feng Lee
- Department of Emergency MedicineNg Teng Fong General HospitalSingapore
| |
Collapse
|
41
|
Melo MDTD, Paiva MG, Santos MVC, Rochitte CE, Moreira VDM, Saleh MH, Brandão SCS, Gallafrio CC, Goldwasser D, Gripp EDA, Piveta RB, Silva TO, Santo THCE, Ferreira WP, Salemi VMC, Cauduro SA, Barberato SH, Lopes HMC, Pena JLB, Rached HRS, Miglioranza MH, Pinheiro AC, Vrandecic BALM, Cruz CBBV, Nomura CH, Cerbino FME, Costa IBSDS, Coelho Filho OR, Carneiro ACDC, Burgos UMMC, Fernandes JL, Uellendahl M, Calado EB, Senra T, Assunção BL, Freire CMV, Martins CN, Sawamura KSS, Brito MM, Jardim MFS, Bernardes RJM, Diógenes TC, Vieira LDO, Mesquita CT, Lopes RW, Segundo Neto EMV, Rigo L, Marin VLS, Santos MJ, Grossman GB, Quagliato PC, Alcantara MLD, Teodoro JAR, Albricker ACL, Barros FS, Amaral SID, Porto CLL, Barros MVL, Santos SND, Cantisano AL, Petisco ACGP, Barbosa JEM, Veloso OCG, Spina S, Pignatelli R, Hajjar LA, Kalil Filho R, Lopes MACQ, Vieira MLC, Almeida ALC. Brazilian Position Statement on the Use Of Multimodality Imaging in Cardio-Oncology - 2021. Arq Bras Cardiol 2021; 117:845-909. [PMID: 34709307 PMCID: PMC8528353 DOI: 10.36660/abc.20200266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | - Mohamed Hassan Saleh
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Daniel Goldwasser
- Hospital Federal de Ipanema, Rio de Janeiro, RJ - Brasil
- Hospital Copa D'Or, Rio de Janeiro, RJ - Brasil
- Casa de Saúde São José, Rio de Janeiro, RJ - Brasil
| | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
| | | | - Tonnison Oliveira Silva
- Hospital Cardio Pulmonar - Centro de Estudos em Cardiologia, Salvador, BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
| | | | | | - Vera Maria Cury Salemi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Silvio Henrique Barberato
- CardioEco Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico, Curitiba, PR - Brasil
| | | | | | | | - Marcelo Haertel Miglioranza
- Instituto de Cardiologia do Rio Grande do Sul - Laboratório de Pesquisa e Inovação em Imagem Cardiovascular, Porto Alegre, RS - Brasil
- Hospital Mãe de Deus, Porto Alegre, RS - Brasil
| | | | | | | | - César Higa Nomura
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Fernanda Mello Erthal Cerbino
- Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ - Brasil
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Juliano Lara Fernandes
- Radiologia Clínica de Campinas, Campinas, SP - Brasil
- Instituto de Ensino e Pesquisa José Michel Kalaf, Campinas, SP - Brasil
| | - Marly Uellendahl
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Tiago Senra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Bruna Leal Assunção
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- ECOCENTER, Belo Horizonte, MG - Brasil
| | | | - Karen Saori Shiraishi Sawamura
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
- Instituto da Criança da Universidade de São Paulo (USP), São Paulo, SP - Brasil
| | - Márcio Miranda Brito
- Universidade Federal do Tocantins - Campus de Araguaina, Araguaina, TO - Brasil
- Hospital Municipal de Araguaina, Araguaina, TO - Brasil
| | | | | | | | | | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
- Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | - Letícia Rigo
- Hospital Beneficência Portuguesa, São Paulo, SP - Brasil
| | | | | | - Gabriel Blacher Grossman
- Clínica Cardionuclear, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Americas Serviços Médicos, Rio de Janeiro, RJ - Brasil
- Rede D'Or, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Simone Nascimento Dos Santos
- Hospital Brasília - Ecocardiografia, Brasília, DF - Brasil
- Eccos Diagnóstico Cardiovascular Avançado, Brasília, DF - Brasil
| | | | | | | | | | | | - Ricardo Pignatelli
- Texas Children's Hospital, Houston, Texas - EUA
- Baylor College of Medicine, Houston, Texas - EUA
| | - Ludhmilla Abrahão Hajjar
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Roberto Kalil Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Marcelo Antônio Cartaxo Queiroga Lopes
- Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, João Pessoa, PB - Brasil
- Hospital Metropolitano Dom José Maria Pires, João Pessoa, PB - Brasil
- Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - André Luiz Cerqueira Almeida
- Santa Casa de Misericórdia de Feira de Santana - Cardiologia, Feira de Santana, BA - Brasil
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia, São Paulo, SP - Brasil
| |
Collapse
|
42
|
Manoukian MAC, Corbett RL, Mumma BE, Darrow MA, Harper RW. A 70-Year-Old Woman With Refractory Hypoxemia. Chest 2021; 160:e265-e268. [PMID: 34488965 DOI: 10.1016/j.chest.2021.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/11/2021] [Accepted: 01/29/2021] [Indexed: 11/28/2022] Open
Abstract
CASE PRESENTATION A 70-year-old woman was transferred to our ED from an outside ED for hypoxemia. Three weeks earlier, an inpatient evaluation for syncope revealed a right intraventricular filling defect, multiple pulmonary nodules, pulmonary emboli, and a left breast mass. She underwent breast biopsy, was started on rivaroxaban, and was discharged with outpatient follow-up. She experienced progressively worsening dyspnea, prompting a return to the outside ED, where she was found to be severely hypoxemic and was intubated. Her medical history included diabetes, hypertension, hyperlipidemia, COPD, hypothyroidism, diastolic heart failure, and a 40+ pack-year smoking history.
Collapse
Affiliation(s)
| | - Rebecca L Corbett
- Department of Internal Medicine, Division of Pulmonary Care, Critical Care and Sleep Medicine, UC Davis, Sacramento, CA
| | - Bryn E Mumma
- Department of Emergency Medicine, UC Davis, Sacramento, CA
| | - Morgan A Darrow
- Department of Pathology and Laboratory Medicine, UC Davis, Sacramento, CA
| | - Richart W Harper
- Department of Internal Medicine, Division of Pulmonary Care, Critical Care and Sleep Medicine, UC Davis, Sacramento, CA
| |
Collapse
|
43
|
Sovic WR, Arunthamakun J, Lemieux A, Guileyardo JM. Papillary fibroelastoma in the left ventricle. Proc (Bayl Univ Med Cent) 2021; 34:623-624. [PMID: 34456493 DOI: 10.1080/08998280.2021.1914454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
We present a 61-year-old woman with a recent transient ischemic attack who presented with presyncope and was ultimately found to have a papillary fibroelastoma at the apex of her left ventricle. She underwent minimally invasive excision of the tumor.
Collapse
Affiliation(s)
- William R Sovic
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Justin Arunthamakun
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Ariane Lemieux
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | | |
Collapse
|
44
|
Russo D, Cinque A, Velardi L, Schino S, Perrone FNS, Beggio E, Romeo F, Gaspardone A. Giant pericardial mass case report: role of echocardiography. AME Case Rep 2021; 5:23. [PMID: 34312602 DOI: 10.21037/acr-20-141] [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: 09/22/2020] [Accepted: 03/07/2021] [Indexed: 11/06/2022]
Abstract
Cardiac masses are rare and they are distinguished in tumors and non-tumoral masses. Primary pericardial masses are very rare and they are often asymptomatic, even if they can present with sudden cardiac death. The diagnosis of these masses is often accidental and they are generally identified with echocardiography; their characterization is usually performed by cardiac magnetic resonance imaging (MRI) but the definitive diagnosis is achieved by tissue biopsy. We described a case of primary pericardial mass in an old patient with history of hypertension, which presented at our hospital with dyspnea and low-extremity edema. The echocardiography described a giant iso/hypoechoic pericardial mass that extended on anterior, posterior and lateral walls of left ventricle and atrium, associated with pericardial effusion without hemodynamic compromise. We discovered that the mass was identified twenty years ago on a chest-computed tomography (CT). Even if we do not manage in performing a cardiac MRI, from echo characteristics we supposed that the mass was a lipoma. Lipomas are benign tumors that can develop from pericardium and they have slow growth so they can be asymptomatic for several years. Their excision is important because they may be responsible for pericardial tamponade or heart failure. Echocardiography is an economic non-invasive exam and it is helpful in differential diagnosis, treatment, follow-up and prognosis of this cardiac masses.
Collapse
Affiliation(s)
- Debora Russo
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy.,Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | | | - Laura Velardi
- Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | - Sofia Schino
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy.,Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | - Fabrizio Nicolò Stefano Perrone
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy.,Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | - Elisa Beggio
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy.,Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | - Francesco Romeo
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy
| | | |
Collapse
|
45
|
Miyawaki M, Aoyama R, Ishikawa J, Harada K. Primary cardiac B cell lymphoma in an immunocompetent patient. BMJ Case Rep 2021; 14:14/7/e243068. [PMID: 34312135 PMCID: PMC8314727 DOI: 10.1136/bcr-2021-243068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary cardiac lymphoma is a rare entity of extranodal lymphoma and is observed with increasing frequency in immunocompromised hosts. However, a considerable proportion of cardiac lymphomas still occur in immunocompetent patients. We report the case of a 55-year-old immunocompetent Japanese man with a large amount of pericardial fluid and the presentation of heart failure secondary to primary cardiac B cell lymphoma, which was diagnosed by cytological examination of pericardial fluid and imaging. The right atrium, right ventricle and pericardium were affected by the tumour, which encased the mid/distal portion of the right coronary artery (RCA). Pretreatment optical coherence tomography of the RCA demonstrated no tumour extension into the vascular structure but a focal mural thrombus. We initiated chemotherapy (steroid therapy then COP at half dose/R-CHOP/R-CHASE) [COP (C: Cyclophosphamide, O: Oncovin, P: Prednisolone) R-CHOP (R: Rituximab, C: Cyclophosphamide, H: Doxorubicin Hydrochloride, O: Oncovin, P: Prednisolone) R-CHASE (R: Rituximab, C: Cyclophosphamide, HA: high dose Cytarabine, S: Steroid, E: Etoposide)]with administration of low-dose aspirin to prevent possible ischaemic events. The patient had a good clinical course without adverse events except for transient pericarditis.
Collapse
Affiliation(s)
- Masashi Miyawaki
- Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Rie Aoyama
- Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Joji Ishikawa
- Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Kazumasa Harada
- Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| |
Collapse
|
46
|
Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology. Biomedicines 2021; 9:biomedicines9070774. [PMID: 34356838 PMCID: PMC8301302 DOI: 10.3390/biomedicines9070774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Primary malignant cardiac tumors are rare, with a prevalence of about 0.01% among all cancer histotypes. At least 60% of them are primary soft tissue sarcomas of the heart (pSTS-h) that represent almost 1% of all STSs. The cardiac site of origin is the best way to classify pSTS-h as it is directly linked to the surgical approach for cancer removal. Indeed, histological differentiation should integrate the classification to provide insights into prognosis and survival expectancy of the patients. The prognosis of pSTS-h is severe and mostly influenced by the primary localization of the tumor, the difficulty in achieving complete surgical and pharmacological eradication, and the aggressive biological features of malignant cells. This review aims to provide a detailed literature overview of the most relevant issues on primary soft tissue sarcoma of the heart and highlight potential diagnostic and therapeutic future perspectives.
Collapse
|
47
|
Schultz KL, Quinn SM, Miller AH, Fieman RE, Cipolle MD, Misselbeck TS, Roth KR. Point of care ultrasound facilitated diagnosis of right ventricular mass as the etiology of syncope; A case report of intravenous leiomyomatosis. Radiol Case Rep 2021; 16:1288-1293. [PMID: 33854666 PMCID: PMC8026911 DOI: 10.1016/j.radcr.2021.02.062] [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: 12/14/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Syncope is a common emergency department (ED) chief complaint. Rarely, syncope can be the result of right ventricular outflow obstruction from an intracardiac tumor, such as an intracardiac extension of intravenous leiomyomatosis (IVL). Typically, this type of tumor is confined to the pelvic veins, but in very rare cases, it can extend through the inferior vena cava into the right atrium. Point-of-care ultrasound (POCUS) can be a crucial tool in the ED for identifying intracardiac tumors presenting as syncope and expediting clinical management. We present the case of a 39-year-old female with no prior medical history that presented to the ED having experienced dyspnea on exertion and two syncopal episodes prior to ED admission. POCUS use in the ED elucidated the presence of a right atrial mass and further imaging showed a mass on the patient's uterus. After surgical removal of a portion of the atrial mass, a subsequent biopsy revealed it had leiomyoma-like features; as such, the patient was diagnosed with IVL. This case illustrates the importance of using POCUS in the ED to help determine the etiology of syncope. Although intracardiac extensions of IVL are rare, it is important for emergency physicians to keep this diagnosis in the differential in patients with symptoms or risk factors suggestive of IVL with intracardiac extension.
Collapse
Affiliation(s)
- Kristine L Schultz
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Shawn M Quinn
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Andrew H Miller
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Rachel E Fieman
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Mark D Cipolle
- Department of Surgery, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Timothy S Misselbeck
- Department of Surgery, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| | - Kevin R Roth
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown PA 18103, USA
| |
Collapse
|
48
|
Left atrial thrombus resembling myxoma during sinus rhythm in a patient with mitral stenosis. J Echocardiogr 2021; 20:238-239. [PMID: 33638803 DOI: 10.1007/s12574-021-00522-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
|
49
|
Yu S, Peffley S, Fabbro M, Mohammed AN. A Narrative Review of the 2020 Guidelines for Use of Transesophageal Echocardiography to Assist with Surgical Decision- Making by the Cardiac Anesthesiologist in the Operating Room. J Cardiothorac Vasc Anesth 2021; 36:258-274. [PMID: 33744115 DOI: 10.1053/j.jvca.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/25/2023]
Abstract
Transesophageal echocardiography (TEE) has become an integral part in helping to diagnose, manage, and assess interventions in the cardiac operating room. Multiple guidelines have been created by the American Society of Echocardiography for performing a TEE examination for different cardiac pathologies. The operating room can provide unique challenges when performing a TEE examination, which include hemodynamic instability, time constraints, and use of general anesthesia. The Guideline for the use of TEE to assist in surgical decision- making in the operating room recently was published to provide a starting protocol for conducting a TEE examination for different cardiac surgeries and for using the information obtained to interpret and to communicate findings to the surgical team. This present narrative review focuses and expands upon the relevant portions for the cardiac anesthesiologist.
Collapse
Affiliation(s)
- Soojie Yu
- Department of Anesthesiology, University of Arizona College of Medicine, Tucson, AZ.
| | - Sultana Peffley
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL
| | - Michael Fabbro
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL
| | - Asif Neil Mohammed
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
50
|
Nakagawa-Kamiya T, Mori M, Ohira M, Iino K, Kawashiri MA, Takemura H, Takamura M. Intimal Sarcoma: An Extremely Rare Case of a Left Atrial Tumor with Partial Obstruction of the Mitral Orifice. ACTA ACUST UNITED AC 2021; 5:93-96. [PMID: 33912776 PMCID: PMC8071820 DOI: 10.1016/j.case.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Primary malignant cardiac tumors are very rare. This is the first case report of intimal sarcoma of left atrial origin. Echocardiographic diagnosis of malignant cardiac tumor is critical but challenging. The authors outline the differentiation of primary malignant cardiac tumors.
Collapse
Affiliation(s)
- Tamami Nakagawa-Kamiya
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Mika Mori
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Miho Ohira
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kenji Iino
- Department of Cardiovascular Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| |
Collapse
|