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Dragicevic-Antonic M, Rankovic-Nicic L, Stamenkovic G, Petrovic M, Loncar G, Markovic N, Dimitrijevic A, Bulatovic S, Cirkovic M, Borzanovic B, Antonic Z, Pirnat M, Manka R, Bojic M. Cardiac Angiosarcoma in the Right Atrium Treated by Surgical Resection. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1321. [PMID: 39202602 PMCID: PMC11356060 DOI: 10.3390/medicina60081321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024]
Abstract
We present the case of a 49-year-old female of Caucasian European descent with chest tightness, fatigue, and palpitations, ultimately diagnosed with primary intracardiac angiosarcoma. Initial echocardiography revealed a significant mass within the right atrium, infiltrating the free wall. Surgical intervention included tumor excision and partial resection of the superior vena cava. Histopathological examination confirmed a high-grade angiosarcoma. Postoperative imaging identified a recurrent mass in the right atrium, suggestive of thrombus, alongside Takotsubo cardiomyopathy. Considering the elevated surgical risks and the presence of cardiomyopathy, management included anticoagulation therapy with Warfarin and adjuvant chemotherapy with Paclitaxel. Follow-up cardiac magnetic resonance imaging demonstrated a recurrent angiosarcoma with superimposed thrombus. This case presents the complex diagnostic and therapeutic landscape of angiosarcoma, highlighting the critical importance of early surgical intervention, advanced imaging techniques, and vigilant postoperative monitoring.
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Affiliation(s)
| | - Ljiljana Rankovic-Nicic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Masa Petrovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Goran Loncar
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nikola Markovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
| | - Ana Dimitrijevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Sulin Bulatovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Cirkovic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
| | | | - Zelimir Antonic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
| | - Maja Pirnat
- Maribor University Clinical Center, 2000 Maribor, Slovenia
| | - Robert Manka
- University Hospital of Zürich, 8091 Zürich, Switzerland
| | - Milovan Bojic
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
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Finke K, Gietzen T, Steven D, Baldus S, ten Freyhaus H, Maintz D, Pennig L, Gietzen C. Cardiac fibromas in adult patients: a case series focusing on rhythmology and radiographic features. Eur Heart J Case Rep 2024; 8:ytae410. [PMID: 39171139 PMCID: PMC11337122 DOI: 10.1093/ehjcr/ytae410] [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: 02/06/2024] [Revised: 05/21/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Abstract
Background Fibromas are rare primary benign cardiac tumours that can become symptomatic due to expansive growth, ventricular rhythm disturbances, and sudden cardiac death. Distinguishing fibromas from other (malign) cardiac masses is essential for accurate diagnosis and treatment. While there is some experience in management of cardiac fibromas in children, management of adult patients is unknown. Case summary We present three cases of cardiac fibroma in adult patients diagnosed by echocardiography, cardiovascular magnetic resonance (CMR), and computed tomography (CT): (1) a 55-year-old male with a left ventricular fibroma leading to reduced left ventricular ejection fraction and mitral regurgitation. He had family history of sudden cardiac death, showed premature ventricular contractions (PVCs), and was treated with a primary preventive subcutaneous implantable cardiac defibrillator (S-ICD); (2) a 39-year-old male with right ventricular fibroma as an incidental finding. He complained of episodes of PVC. Due to a low PVC burden, decision was made against ablation and the patient was planned for follow-up; and (3) an 18-year-old female with left ventricular apex fibroma detected by CMR shortly after birth and confirmed by surgical biopsy. Being asymptomatic, conservative management was pursued and follow-up by CMR planned. Discussion Cardiac fibromas can show various clinical presentations and hence being detected late in life. Given potential complications of surgical biopsy, diagnosis of cardiac fibromas is primarily based on echocardiography, CT, and CMR. Rhythm disturbances as PVCs are common. Due to association with ventricular arrhythmias and sudden cardiac death, preventive ICD placement might be appropriate on an individual basis.
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Affiliation(s)
- Karl Finke
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - Thorsten Gietzen
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - Daniel Steven
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - Henrik ten Freyhaus
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937 Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Gietzen
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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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.
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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.)
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Otchere P, Pak S, Ulloa-Rodriguez J, Fierro M, Sharma A, Poku T, Kofi-Obeng B, Yang E, Thallapureddy K. Complex decision making in a patient with lung cancer with incidentally found fast-growing atrial mass. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:30. [PMID: 38762470 PMCID: PMC11102299 DOI: 10.1186/s40959-024-00219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/11/2024] [Indexed: 05/20/2024]
Abstract
Atrial myxomas are typically found in the left atrium and are the most common among overall rare cardiac tumors. Herein, we describe the clinical course of a 72-year-old female with non-small cell lung adenocarcinoma found to have an atrial mass during an imaging for evaluation for lung cancer progression. Differentiating between distinct types of masses can pose a challenge to the treatment team especially in the setting of exiting malignancy. This case demonstrates the complex decision making involved in the diagnosis, and timing of intervention to remove atrial mass in patients with frailty and a fast-growing cardiac mass.
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Affiliation(s)
- Prince Otchere
- Department of Cardio-Oncology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Stella Pak
- Department of Neurology, Albany Medical Center, 43 New Scotland Ave, Albany, NY, 12208, USA.
| | - Juan Ulloa-Rodriguez
- Department of Cardiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Maria Fierro
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Aditi Sharma
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Tevonne Poku
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Eric Yang
- Department of Cardiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Keerthi Thallapureddy
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX, USA
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5
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AlRasheed MM. Genetics of Cardiac Tumours: A Narrative Review. Heart Lung Circ 2024; 33:639-647. [PMID: 38161083 DOI: 10.1016/j.hlc.2023.11.005] [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: 04/27/2023] [Revised: 10/09/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
Cardiac tumours can occur in association with genetic syndromes. Rhabdomyomas have been reported in association with tuberous sclerosis, myxomas with Carney's complex, cardiac fibromas with Gorlin syndrome, and paragangliomas with multiple endocrine neoplasm syndrome. The presentation and prognosis of cardiac tumours associated with genetic syndromes differ compared with sporadic cases. Knowledge about the associated syndromes' genetic features and extracardiac manifestations is essential for the diagnosis, prognosis, and management of cardiac neoplasms. Moreover, identifying genetic mutations in benign and malignant cardiac tumours is needed to personalise management and improve treatment outcomes. Thus, this review discusses the genetic abnormalities associated with cardiac tumours, the current genetic screening recommendations, and the effect of those genetic mutations on the outcomes.
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Affiliation(s)
- Maha M AlRasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
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6
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Mousavizadeh Ahmadabadi SM, Banar S, Parvas E, Shahbazi N, Biranvand H. Uncommon manifestation of multiple myeloma: A case report of intracardiac plasmacytoma presenting with severe heart failure and bilateral pleural effusion. Int J Surg Case Rep 2024; 114:109187. [PMID: 38160518 PMCID: PMC10800586 DOI: 10.1016/j.ijscr.2023.109187] [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: 11/01/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Extramedullary intracardiac plasmacytoma is a rare type of plasma cell neoplasm that involves the heart. This article presents a case report of a patient with this condition and describes the surgical management of the disease. CASE PRESENTATION The patient was a 65-year-old male with a history of multiple myeloma in remission for two years who presented with shortness of breath and chest pain. Imaging studies revealed a mass in the right atrium of the heart, which was confirmed to be extramedullary intracardiac plasmacytoma on biopsy. The patient underwent surgical resection of the mass. CLINICAL DISCUSSION Extramedullary intracardiac plasmacytoma is a rare condition that can occur in patients with multiple myeloma. Early diagnosis and prompt treatment are crucial for improving the prognosis of affected individuals. Surgical resection may be a viable treatment option for some patients. CONCLUSION This case report highlights the potential risks and complications associated with surgical intervention in patients with extramedullary intracardiac plasmacytoma. Further research is needed to determine the best treatment approach for this rare condition and to improve patient outcomes.
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Affiliation(s)
- Seyed Mohammadali Mousavizadeh Ahmadabadi
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Shahid Rajaei Research & Training Hospital, Next to Mellat Park, Vali-Asr Ave, Tehran Postal code: 1995614331, Iran
| | - Sepideh Banar
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Shahid Rajaei Research & Training Hospital, Next to Mellat Park, Vali-Asr Ave, Tehran Postal code: 1995614331, Iran
| | - Ehsan Parvas
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran
| | - Narges Shahbazi
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran
| | - Hamidreza Biranvand
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran.
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Wood CA, Gunther RS, O'Gorman KJ, Kelly F, Lisanti CJ. An Intramyocardial Lipoma Mimicking Post-infarction Fatty Changes: Discussion of Key Distinguishing Imaging Findings and Clinical Implications. Cureus 2023; 15:e46955. [PMID: 38022295 PMCID: PMC10640719 DOI: 10.7759/cureus.46955] [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: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiac lipomas are benign primary cardiac tumors that are most often asymptomatic and diagnosed incidentally. Cardiac magnetic resonance imaging (MRI) is the imaging modality of choice when aiming to characterize these tumors. A minority of cardiac lipomas are intramyocardial, which, when combined with the much more common post-infarction fatty metaplasia, makes diagnosing these lipomas very challenging. We review a case of intramyocardial lipoma in the distal interventricular septum that was initially detected on a low-dose computed tomography for lung cancer screening and the subsequent findings on cardiac MRI that made the diagnosis. Additionally, this case also helps to support the conservative management of intramyocardial lipomas that are more distal in the left ventricle and subsequently at lower risk for conduction arrhythmias.
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Affiliation(s)
- Charles A Wood
- Radiology, New York Institute of Technology College of Osteopathic Medicine at Arkansas State, Jonesboro, USA
| | - Rutger S Gunther
- Nuclear Medicine/Radiology, Brooke Army Medical Center, Fort Sam Houston, USA
| | | | - Faith Kelly
- Cardiology, Brooke Army Medical Center, Fort Sam Houston, USA
- Cardiology, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Christopher J Lisanti
- Radiology, Brooke Army Medical Center, Fort Sam Houston, USA
- Radiology, Uniformed Services University of the Health Sciences, Bethesda, USA
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8
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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.
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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
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Inserra MC, Cannizzaro MT, Passaniti G, Celona A, Secinaro A, Curione D, D'Angelo T, Garretto O, Romeo P. MR imaging of primary benign cardiac tumors in the pediatric population. Heliyon 2023; 9:e19932. [PMID: 37809686 PMCID: PMC10559362 DOI: 10.1016/j.heliyon.2023.e19932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/25/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Primary cardiac tumors are rare in all ages, especially in children, with a reported prevalence range of 0.0017-0.28% in autopsy series. Due to their rarity, the diagnostic and therapeutic pathways reserved to them are usually described by single case reports, leading to the point where a common diagnostic protocol is imperative to obtain a differential diagnosis. The first diagnostic approach is done with transthoracic echocardiogram (TTE), due to its wide availability, low cost, absence of ionizing radiations and non-invasiveness. Several tumors are discovered incidentally and, in many cases, TTE is helpful to determine location, size and anatomical features, playing a key role in the differential diagnosis. In the last few years, cardiac magnetic resonance imaging (CMR) has had an increased role in the diagnostic pathway of pediatric cardiac masses, due to its high accuracy in characterizing mass tissue properties (especially for soft tissue), and in detecting tumor size, extent, pericardial/pleural effusion, leading to the correct diagnosis, treatment and follow-up. Therefore, nowadays, several consensus statements consider CMR as a leading imaging technique, thanks to its non-invasive tissue characterization, without the use of ionizing radiation, in an unrestricted field of view. As suggested by the most recent literature, the pediatric protocol is not so different from the adult one, adapted to the size and cardiac frequency of the patient, sometimes requiring special conditions such as free-breathing sequences and/or sedation or general anesthesia in non-cooperating patients.
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Affiliation(s)
| | | | - Giulia Passaniti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Antonio Celona
- UOC Radiodiagnostica, San Vincenzo Hospital, Provincial Health Agency of Messina, Taormina, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Curione
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, Messina Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Orazio Garretto
- UOSD Radiologia 2 CAST, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco”, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
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Haider I, Ullah H, Fatima M, Karim MS, Haq FU, Majid A, Anwar MS, Nawaz FK, Ali I, Sarwar AH, Anwar MT, Khan AW, Humayun O, Alam F. Tissue characterization of benign cardiac tumors by cardiac magnetic resonance imaging, a review of core imaging protocol and benign cardiac tumors. Front Cardiovasc Med 2023; 10:1009411. [PMID: 37441708 PMCID: PMC10333494 DOI: 10.3389/fcvm.2023.1009411] [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: 08/05/2022] [Accepted: 04/18/2023] [Indexed: 07/15/2023] Open
Abstract
Generally, cardiac masses are initially suspected on routine echocardiography. Cardiac magnetic resonance (CMR) imaging is further performed to differentiate tumors from pseudo-tumors and to characterize the cardiac masses based on their appearance on T1/T2-weighted images, detection of perfusion and demonstration of gadolinium-based contrast agent uptake on early and late gadolinium enhancement images. Further evaluation of cardiac masses by CMR is critical because unnecessary surgery can be avoided by better tissue characterization. Different cardiac tissues have different T1 and T2 relaxation times, principally owing to different internal biochemical environments surrounding the protons. In CMR, the signal intensity from a particular tissue depends on its T1 and T2 relaxation times and its proton density. CMR uses this principle to differentiate between various tissue types by weighting images based on their T1 or T2 relaxation times. Generally, tumor cells are larger, edematous, and have associated inflammatory reactions. Higher free water content of the neoplastic cells and other changes in tissue composition lead to prolonged T1/T2 relaxation times and thus an inherent contrast between tumors and normal tissue exists. Overall, these biochemical changes create an environment where different cardiac masses produce different signal intensity on their T1- weighted and T2- weighted images that help to discriminate between them. In this review article, we have provided a detailed description of the core CMR imaging protocol for evaluation of cardiac masses. We have also discussed the basic features of benign cardiac tumors as well as the role of CMR in evaluation and further tissue characterization of these tumors.
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Affiliation(s)
- Imran Haider
- Radiology Department, Saint Luke’s Hospital, Chesterfield, MO, United States
| | - Hameed Ullah
- Internal Medicine Department, Hayatabad Medical Complex (HMC), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | | | | - Furqan Ul Haq
- Internal Medicine Department, Mayo Hospital, Lahore, Punjab, Pakistan
| | - Abdul Majid
- Department of Radiation Oncology, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Saad Anwar
- Internal Medicine Department, King Edward Medical University, Lahore, Punjab, Pakistan
| | - Fatima Kausar Nawaz
- Sheikh Zayed Medical College, Pakistan
- Khyber Girls Medical College, Peshawar, Pakistan
| | - Ijaz Ali
- Internal Medicine Department, Hayatabad Medical Complex (HMC), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Atif Hussain Sarwar
- Internal Medicine Department, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College Hospital: Shaikh Zayed Hospital, Lahore, Pakistan
| | - Muhammad Tayyab Anwar
- Internal Medicine Department, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Abdul Wali Khan
- Internal Medicine Department, Gujranwala Medical College, Gujranwala, Punjab, Pakistan
| | - Omama Humayun
- Internal Medicine Department, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Chiocchi M, Luciano A, De Stasio V, Pugliese L, Picchi E, Di Donna C, Volpe M, Pitaro M, Garaci F, Floris R. Cardiac lipoma of the interventricular septum presenting with chest pain. Radiol Case Rep 2023; 18:1886-1889. [PMID: 36936801 PMCID: PMC10020461 DOI: 10.1016/j.radcr.2023.02.003] [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: 11/27/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 03/11/2023] Open
Abstract
In this case report, we describe an incidental finding of interventricular septum lipoma in a 55-year-old man who came to our attention for chest pain. The ECG showed no changes compatible with ongoing ischemia. While laboratory tests documented increased troponin levels with normal D-dimer levels. Due to the technical difficulties encountered during the performance of the transthoracic echocardiogram, a cardiac CT scan was requested, which ruled out significant coronary artery disease and acute aortic syndromes and showed the presence of a circumscribed fat-dense mass located in the basal portion of the interventricular septum. Subsequent cardiac MRI confirmed the diagnosis of lipoma of the interventricular septum.
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12
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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.
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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.
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13
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The Merits, Limitations, and Future Directions of Cost-Effectiveness Analysis in Cardiac MRI with a Focus on Coronary Artery Disease: A Literature Review. J Cardiovasc Dev Dis 2022; 9:jcdd9100357. [PMID: 36286309 PMCID: PMC9604922 DOI: 10.3390/jcdd9100357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging has a wide range of clinical applications with a high degree of accuracy for many myocardial pathologies. Recent literature has shown great utility of CMR in diagnosing many diseases, often changing the course of treatment. Despite this, it is often underutilized possibly due to perceived costs, limiting patient factors and comfort, and longer examination periods compared to other imaging modalities. In this regard, we conducted a literature review using keywords “Cost-Effectiveness” and “Cardiac MRI” and selected articles from the PubMed MEDLINE database that met our inclusion and exclusion criteria to examine the cost-effectiveness of CMR. Our search result yielded 17 articles included in our review. We found that CMR can be cost-effective in quality-adjusted life years (QALYs) in select patient populations with various cardiac pathologies. Specifically, the use of CMR in coronary artery disease (CAD) patients with a pretest probability below a certain threshold may be more cost-effective compared to patients with a higher pretest probability, although its use can be limited based on geographic location, professional society guidelines, and differing reimbursement patterns. In addition, a stepwise combination of different imaging modalities, with conjunction of AHA/ACC guidelines can further enhance the cost-effectiveness of CMR.
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14
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Ismail B, Elmalı M, Baysal K. MRI diagnosed cardiac lipoma in tuberous sclerosis: a case report with a very rare association. Cardiol Young 2022; 33:1-3. [PMID: 36184830 DOI: 10.1017/s1047951122003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tuberous sclerosis is a genetic multisystem disorder characterised by hamartomas in several organs. Cardiac rhabdomyomas are the main features of the disease but lipomas can very rarely be associated. Herein, we present a very rare association of tuberous sclerosis and cardiac lipoma detected by echocardiography and diagnosed as a lipoma via MRI and fat suppression technic, aim to report this very rare association, and emphasise usefulness of MRI in cardiac mass lesions.
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Affiliation(s)
- Balaban Ismail
- Yeni Yuzyil University Faculty of Medicine, Department of Pediatric Cardiology, Istanbul, Turkey
| | - Muzaffer Elmalı
- Ondokuz Mayis University Faculty of Medicine, Department of Pediatric Radiology, Samsun, Turkey
| | - Kemal Baysal
- Ondokuz Mayis University Faculty of Medicine, Department of Pediatric Radiology, Samsun, Turkey
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15
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Komoriya Y, Suzuki S, Iwakawa N, Kondo T, Murohara T. A rare case of cardiac tumor of the interventricular septum complicated with atrioventricular block. J Cardiol Cases 2022; 26:419-422. [PMID: 36506495 PMCID: PMC9727565 DOI: 10.1016/j.jccase.2022.09.002] [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: 02/28/2022] [Revised: 07/30/2022] [Accepted: 08/26/2022] [Indexed: 12/15/2022] Open
Abstract
Lipomatous hypertrophy of the interatrial septum is a rare benign condition characterized by adipocyte hyperplasia with fat infiltration between the myocardial fibers in the interatrial septum. Although lipomatous hypertrophy does not occur only in the interatrial septum, its location in the interventricular septum is extremely rare. A 45-year-old woman with no medical or family history of cardiac disease presented with an episode of syncope. Transthoracic echocardiography revealed an echogenic mass in the interventricular septum and no outflow obstruction. The mass-like area showed fat tissue-specific features on computed tomography and magnetic resonance imaging, and furthermore, it showed late gadolinium enhancement. We diagnosed it as lipomatous hypertrophy of the interventricular septum. An implantable loop recorder documented paroxysmal complete atrioventricular block with presyncope. A permanent dual-chamber pacemaker was implanted. This is the first reported case of lipomatous hypertrophy of the interventricular septum treated with a pacemaker for complete atrioventricular block with syncope. We have described the case and the treatment strategy in detail. Learning objective To understand lipomatous hypertrophy, a rare disorder, and its characteristics and differences between lipomatous hypertrophy and cardiac adipose tumors on computed tomography and magnetic resonance imaging. To learn about the appropriate treatment and clinical management of this benign condition and treat symptomatic patients.
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Affiliation(s)
- Yasuyo Komoriya
- Department of Cardiology, Tokoname City Hospital, Aichi, Japan
| | - Susumu Suzuki
- Department of Cardiology, Handa City Hospital, Aichi, Japan,Corresponding author at: 2-29 Handa City Hospital, Toyo-cho, Handa 475-8599, Japan.
| | - Naoki Iwakawa
- Department of Cardiology, Tokoname City Hospital, Aichi, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
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16
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Stone ML, Albertz ML, Galambos C, Twite MD, Campbell DN, Di Maria M, Fonseca B, Miyamoto SD, Ing RJ. Multi-Disciplinary Management and Surgical Resection of Intracardiac Fibromas Causing Bilateral Ventricular Outflow Tract Obstructions in an Infant. Semin Cardiothorac Vasc Anesth 2022; 26:315-322. [PMID: 36006828 DOI: 10.1177/10892532221123693] [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: 11/16/2022]
Abstract
Cardiac tumors remain rare in children with benign pathologies predominating. Indications for surgical management often result from compromised ventricular chamber size, biventricular outflow tract obstruction, impaired ventricular function, or the presence of medically refractory dysrhythmias. We present a case of a six-month-old infant with two intracardiac fibromas originating in the interventricular septum. The fibromas were causing significant biventricular outflow obstruction. The patient successfully underwent tumor resection on cardiopulmonary bypass The literature on pediatric cardiac tumors is reviewed. Multi-disciplinary medical planning is necessary for successful anesthetic and surgical treatment of this high-risk patient population.
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Affiliation(s)
- Matthew L Stone
- 129263University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Megan L Albertz
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Csaba Galambos
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Mark D Twite
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - David N Campbell
- 129263University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Michael Di Maria
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Brian Fonseca
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Shelley D Miyamoto
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Richard J Ing
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
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17
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Xie Y, Hong ZL, Zhao YC, Chen S, Lin YC, Wu SS. Percutaneous ultrasound-guided core needle biopsy for the diagnosis of cardiac tumors: Optimizing the treatment strategy for patients with intermural and pericardial cardiac tumors. Front Oncol 2022; 12:931081. [PMID: 35992842 PMCID: PMC9389083 DOI: 10.3389/fonc.2022.931081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The aims of this study are to investigate the clinical value and practical safety of ultrasound-guided percutaneous core needle biopsy on diagnosing cardiac tumor and to discuss the treatment strategy for cardiac intermural and pericardial tumors. Methods The clinical data were retrospectively collected for patients with intermural and pericardial cardiac tumors. The patients were divided into groups of surgical resection, surgical resection after obtaining pathological tissue by PUS-CNB, and/or radiotherapy according to the treatment modality. Ultrasound-guided aspiration biopsy was divided into cardiac tumor biopsy and extracardiac lesion biopsy according to patient conditions. The surgical time was recorded, and the safety and clinical application value of PUS-CNB for the diagnosis of cardiac tumors were evaluated in terms of complications and satisfaction with pathological sampling. Results A total of 18 patient cases were collected, and PUS-CNB of cardiac tumors was performed in 8 cases, with sampling times averaging 15.6 ± 3.0 min. Four cases of cardiac tumors combined with extracardiac tumors were biopsied, with puncture times averaging 13.0 ± 2.9 min. All 12 biopsied patients had no postoperative complications. Except for 1 failed biopsy, the biopsies were successful and the pathological results were consistent with the clinical diagnosis with a satisfaction rate of 91.7%. Except for two cases of surgical resection, the rest were considered for conservative treatment. Surgical resection and/or biopsy were performed in six cases, and two cases were aggravated after surgery. The final pathology of all 17 cardiac tumors was malignant. Conclusion PUS-CNB is safe and effective, providing a simple and undemanding method for accurate diagnosis of cardiac intermural and pericardial tumors while avoiding unnecessary open-heart surgery.
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Affiliation(s)
- Ying Xie
- Department of Hematology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Zhi-liang Hong
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yan-chun Zhao
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yu-cheng Lin
- Department of Ultrasonography, Affiliated Fuzhou First Hospital of Fujian Medical University, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Song-song Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Song-song Wu,
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18
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Shou BL, Halub ME, Zhou AL, Thompkins BA, Choi CW. Massive left atrial thrombus evades multimodality imaging as a myxoma in a bicaval heart transplant recipient. J Card Surg 2022; 37:2884-2887. [PMID: 35789119 DOI: 10.1111/jocs.16708] [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: 02/09/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Intracardiac masses are an extremely rare and poorly described complication following a bicaval heart transplantation. We describe the case of an asymptomatic 62-year-old male with a large left atrial mass found incidentally on transthoracic echocardiography 6 years post-transplant. A battery of additional imaging tests was ordered including transesophageal echocardiography, 18 F-fluorodeoxyglucose positron emission tomography/computed tomography, and T1 and T2 magnetic resonance imaging. Although imaging biomarkers were generally nonspecific, the mass was most consistent with a cardiac myxoma. However, intraoperative findings confirmed by pathology revealed a massive organizing thrombus. The patient had an uneventful recovery after surgical removal of the mass. Our case highlights a very rare phenomenon in heart transplant recipients which remains a unique diagnostic challenge even with current advances in imaging.
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Affiliation(s)
- Benjamin L Shou
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meghan E Halub
- Division of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alice L Zhou
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bryon A Thompkins
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chun W Choi
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Cardiothoracic Surgery, Virtua Health, Virtua Our Lady of Lourdes Hospital, Camden, New Jersey, USA
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19
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Lee JW, Park CH, Im DJ, Lee KH, Kim TH, Han K, Hur J. CT-based radiomics signature for differentiation between cardiac tumors and a thrombi: a retrospective, multicenter study. Sci Rep 2022; 12:8173. [PMID: 35581366 PMCID: PMC9114026 DOI: 10.1038/s41598-022-12229-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 05/06/2022] [Indexed: 12/20/2022] Open
Abstract
The study aimed to develop and validate whether the computed tomography (CT) radiomics analysis is effective in differentiating cardiac tumors and thrombi. For this retrospective study, a radiomics model was developed on the basis of a training dataset of 192 patients (61.9 ± 13.3 years, 90 men) with cardiac masses detected in cardiac CT from January 2010 to September 2019. We constructed three models for discriminating between a cardiac tumor and a thrombus: a radiomics model, a clinical model, which included clinical and conventional CT variables, and a model that combined clinical and radiomics models. In the training dataset, the radiomics model and the combined model yielded significantly higher differentiation performance between cardiac tumors and cardiac thrombi than the clinical model (AUC 0.973 vs 0.870, p < 0.001 and AUC 0.983 vs 0.870, p < 0.001, respectively). In the external validation dataset with 63 patients (59.8 ± 13.2 years, 26 men), the combined model yielded a larger AUC compared to the clinical model (AUC 0.911 vs 0.802, p = 0.037). CT radiomics analysis is effective in differentiating cardiac tumors and thrombi. In conclusion, the combination of clinical, conventional CT, and radiomics features demonstrated an additional benefit in differentiating between cardiac tumor and thrombi compared to clinical data and conventional CT features alone.
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, South Korea
| | - Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Kye Ho Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Tae Hoon Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Jin Hur
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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20
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Multiple cardiac metastases from urothelial carcinoma case report. Egypt Heart J 2022; 74:28. [PMID: 35416567 PMCID: PMC9008108 DOI: 10.1186/s43044-022-00264-y] [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: 02/01/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cardiac metastases are rare and frequently remain undiagnosed due to the absence of clinical signs in the majority of cases. Malignancies found to most commonly metastasise to the heart include lung carcinoma, breast carcinoma and lymphoma, while urothelial carcinoma is a rare cause of cardiac metastasis. The patient presented with pyrexia, a rare presentation of metastatic cardiac involvement. Single metastatic lesions are mainly reported in the literature, while multiple metastatic deposits such as in this case are less common. Case presentation A 74-year-old gentleman presented with frequent febrile spikes, a month after undergoing a nephroureterectomy for poorly differentiated urothelial carcinoma. No febrile source was identified, and a computed tomography identified two cardiac lesions. A transthoracic echocardiogram could not detect the cardiac lesions; therefore, cardiac magnetic resonance (CMR) imaging was performed. Three spherical intramyocardial masses were noted at the basal septum, LV apex and the anteromedial papillary muscle. The lesions demonstrated signal characteristics suggestive of cardiac metastases (high fluid content, absence of fat, presence of a surrounding rim of increased extravascular space, absence of deformation within the masses) from the previously resected urothelial carcinoma. The patient was palliated, and he shortly succumbed to his condition. Conclusions Urothelial carcinoma is an exceedingly rare cause of cardiac metastasis. CMR is an important imaging modality for localisation and characterisation of suspicious cardiac lesions, aiding in the diagnosis of cardiac metastasis.
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21
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Ahmed R, Zaidi S, Feinberg M, Graham-Hill S. Mysterious Left Atrial Mass in a Patient With Metastatic Prostate Cancer. Cureus 2022; 14:e23238. [PMID: 35449657 PMCID: PMC9012572 DOI: 10.7759/cureus.23238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/05/2022] Open
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22
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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.
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23
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Primary and secondary cardiac tumors: clinical presentation, diagnosis, surgical treatment, and results. Gen Thorac Cardiovasc Surg 2022; 70:107-115. [PMID: 35000140 DOI: 10.1007/s11748-021-01754-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/28/2021] [Indexed: 01/04/2023]
Abstract
Cardiac tumours are some of the rarest primary tumours, while cardiac metastasis are more common yet still relatively rare. Seventy five percent of primary cardiac tumours are benign tumours. Cardiac tumours present with a range of obstructive, embolic, arrhythmic or systemic symptoms, and in many cases may present asymptomatically. The clinical presentation depends largely on the size and location of the mass. With advances in cardiac imagining and the introduction of cardiopulmonary bypass, the diagnosis and surgical treatment of these rare tumours has improved the prognosis and outlook for benign and malignant tumours. Management depends on tumour histology, size and location as well as the clinical presentation. Conservative management is reserved for small, benign tumours that can undergo regular echocardiographic follow-up. Symptomatic benign tumours are treated with surgical resection and the results are excellent. Malignant primary cardiac tumours have a poor prognosis with high rates of relapse and a median survival of 10-24 months.
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24
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Bannan B, Ismail HS, Alabdulkarim FM, Sarak B, Vora T, Jimenez-Juan L, Gupta A, Yan AT, Marcuzzi D, Ong G, Latter DA, Nguyen ET, Seidman MA, Cusimano RJ, Deva DP. Right Ventricular Mass 12 Years after Osteosarcoma: Multimodality Imaging with Pathologic Correlation. Radiol Cardiothorac Imaging 2021; 3:e210191. [PMID: 34778786 DOI: 10.1148/ryct.2021210191] [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: 06/30/2021] [Revised: 09/12/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022]
Abstract
The authors report a 27-year-old woman with a remote left femoral osteosarcoma and amputation above the left knee who presented with a large right ventricular mass. Initial evaluation with thoracic CT was inconclusive regarding thrombus versus tumor, but metastatic osteosarcoma was suggested by findings at transthoracic echocardiography, cardiac CT, and cardiac MRI. The patient underwent tumor debulking, and osteosarcoma was confirmed with pathologic examination. She responded to chemotherapy, which resulted in reduction in size of the residual right ventricular tumor and of a few pulmonary metastases. Following induction chemotherapy, patient remains well undergoing maintenance therapy with an oral tyrosine kinase inhibitor. Keywords: CT, Echocardiography, MR Imaging, Intraoperative, Cardiac, Heart, Right Ventricle, Imaging Sequences, Metastases, Oncology Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Badr Bannan
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Huda S Ismail
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Faisal M Alabdulkarim
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Bradley Sarak
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Tushar Vora
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Abha Gupta
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Andrew T Yan
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Danny Marcuzzi
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Géraldine Ong
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - David A Latter
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Elsie T Nguyen
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Michael A Seidman
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Robert J Cusimano
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Djeven P Deva
- Department of Medical Imaging (B.B., H.S.I., F.M.A., L.J.J., A.T.Y., D.M., D.P.D.), Division of Cardiology (B.S., A.T.Y., G.O.), Keenan Research Centre, Li Ka Shing Knowledge Institute (L.J.J., A.T.Y., D.P.D.), Department of Cardiac Surgery (D.A.L.), and Department of Echocardiography (B.S., G.O.), St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (T.V., A.G.); Department of Medicine, University of Toronto, Toronto, Canada (A.T.Y., G.O.); Department of Medical Imaging (E.T.N.), Peter Munk Cardiac Centre (E.T.N.), Laboratory Medicine Program, University Health Network (M.A.S.), Department of Laboratory Medicine and Pathobiology (M.A.S.), and Department of Cardiovascular Surgery (R.J.C.), Toronto General Hospital, University of Toronto, Toronto, Canada
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25
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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
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Giusca S, Kelle S, Korosoglou G. When tissue and outcomes are the issue. Cardiac magnetic resonance for patients with suspected cardiac tumours. Eur Heart J 2021; 43:81-83. [PMID: 36282679 DOI: 10.1093/eurheartj/ehab625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sorin Giusca
- GRN Hospital Weinheim, Department of Cardiology, Vascular Medicine and Pneumology, Weinheim, Germany.,Cardiac Imaging Centre Weinheim, Hector Foundation, Weinheim, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Grigorios Korosoglou
- GRN Hospital Weinheim, Department of Cardiology, Vascular Medicine and Pneumology, Weinheim, Germany.,Cardiac Imaging Centre Weinheim, Hector Foundation, Weinheim, Germany
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Asadian S, Rezaeian N, Hosseini L, Toloueitabar Y, Hemmati Komasi MM. The role of cardiac CT and MRI in the diagnosis and management of primary cardiac lymphoma: A comprehensive review. Trends Cardiovasc Med 2021; 32:408-420. [PMID: 34454052 DOI: 10.1016/j.tcm.2021.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/05/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022]
Abstract
Primary cardiac tumors comprise a distinct category of disorders that result in significant cardiac complications. Primary cardiac lymphomas (PCLs) constitute the second most frequent primary malignancy involving the heart. Without treatment, survival may be limited to just a few months; however, a timely therapeutic schedule may prolong the five-year survival. Accordingly, robust diagnostic modalities are essential to improve prognosis. We herein review the literature available in PubMed, MEDLINE, Cochrane, Google Scholar and Scopus databases. Our review demonstrated that cardiac computed tomography (CT) and magnetic resonance imaging (MRI) employ multiple advanced sequences for tumor characterization with or without a contrast agent. These methods assist not only in differentiating PCLs from other cardiac masses such as cardiac thrombi but also in defining the extent of PCLs and conducting a safe biopsy. Cardiac magnetic resonance (CMR) and CT imaging provide essential knowledge regarding PCLs and cardiotoxicity induced by therapeutic regimens. The application of these robust imaging modalities aids in the early diagnosis of PCLs, accelerates the initiation of the treatment program, and improves patient outcomes significantly. Also presented is our introduction into novel techniques and the feasibility of their use to diagnose and treat cardiac masses, particularly PCLs. It should be mentioned that the paramount role of FDG-PET was not the focus of this paper.
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Affiliation(s)
- Sanaz Asadian
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Nahid Rezaeian
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.
| | - Leila Hosseini
- Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
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28
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Teng F, Yang S, Chen D, Fang W, Shang J, Dong S, Cui Y, Fu W, Zhenga M, Li Y, Lian G. Cardiac fibroma: A clinicopathologic study of a series of 12 cases. Cardiovasc Pathol 2021; 56:107381. [PMID: 34433104 DOI: 10.1016/j.carpath.2021.107381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/01/2021] [Accepted: 08/16/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cardiac fibroma (CF) is a rare tumor that has not been widely reported. This study investigated the clinical findings, histologic features, and differential diagnosis of CF. METHODS A total of 12 CF cases were studied and reviewed using hematoxylin and eosin (H&E), special staining and immunohistochemical staining. The ALK gene was tested in 4 cases of cardiac fibroma with significant inflammatory cells. Clinicopathological data were retrospectively analyzed and followed up. RESULTS The cases occurred in six males and six females ranging in age from 0.5 to 55 years (median, 5 years). The tumors were grossly single and solid (1-17 cm; mean 5.6 cm). The clinical signs and symptoms depended largely on the location of the tumor. Microscopically, the CFs observed were composed of monomorphic spindle cells and abundant collagen. The spindle cells demonstrated little or no atypia. The histology of CFs in infants and young children showed some differences from those in adults. Infants and young children with fibromas exhibited cellular types with more inflammatory infiltration. All tumors expressed vimentin markers. Eleven of 12 cases (91.7%) were positive for SMA by immunohistochemistry. ALK immunostaining and ALK-FISH tests showed negative results. Follow-up information was available for all patients. The mean postoperative follow-up was at 3 years (range 2 months-8.8 years). All patients were alive with no evidence of disease. CONCLUSIONS Our study shows that CFs exhibit a wide morphological spectrum of soft tissue tumors with fibroblastic or myofibroblastic differentiation and/or components. Infants and younger pediatric patients with fibromas have tumors that are more hypercellular and more likely to be misdiagnosed with aggressive or malignant lesions than adults. Finally, the data indicate that CF exhibits benign behavior and that local resection is safe and effective.
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Affiliation(s)
- Fei Teng
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaomin Yang
- Department of Pathology, Peking University Health Science Center, Beijing, China
| | - Dong Chen
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Wei Fang
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianfeng Shang
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Songbo Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yayan Cui
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wen Fu
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Menghan Zhenga
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Yanwei Li
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guoliang Lian
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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29
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Fujita T, Kawaguchi Y, Kataoka Y, Hanaoka J. Cardiac hemangioma producing pericardial effusion detected on thoracoscopic pericardial fenestration. Ann Thorac Surg 2021; 113:e359-e361. [PMID: 34331932 DOI: 10.1016/j.athoracsur.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/01/2022]
Abstract
A 76-year-old woman presented with dyspnea. Computed tomography showed massive pericardial effusion, so percutaneous catheter drainage was performed. The usual causes of exudate were ruled out, and no diagnosis was reached. Thoracoscopic pericardial fenestration was performed for the purpose of pericardial biopsy and to create a passage allowing longer-term drainage. We observed the pericardial cavity after removing effusion, and incidentally revealed a tumor measuring 2 cm in diameter located between the left atrial appendage and left pulmonary artery. Surgical resection of the tumor attached to the left atrial appendage was performed. The pathological diagnosis was hemangioma.
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Affiliation(s)
- Takuya Fujita
- Division of General Thoracic Surgery, Kohka Public Hospital, and Department of Thoracic Surgery, National University Corporation, Shiga University of Medical Science, Shiga, Japan.
| | - Yo Kawaguchi
- Division of General Thoracic Surgery, Kohka Public Hospital, and Department of Thoracic Surgery, National University Corporation, Shiga University of Medical Science, Shiga, Japan
| | - Yoko Kataoka
- Division of General Thoracic Surgery, Kohka Public Hospital, and Department of Thoracic Surgery, National University Corporation, Shiga University of Medical Science, Shiga, Japan
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Kohka Public Hospital, and Department of Thoracic Surgery, National University Corporation, Shiga University of Medical Science, Shiga, Japan
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Tazi I, Benmoussa A, Boufarissi FZ, Sifsalam M, Lahlimi FZ. [Non-Hodgkin cardiac lymphomas]. Ann Cardiol Angeiol (Paris) 2021; 70:237-244. [PMID: 34274110 DOI: 10.1016/j.ancard.2021.06.003] [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: 09/06/2020] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
Cardiac non-Hodgkin lymphoma (CNHL) is a rare extranodal lymphoma with a poor prognosis. Secondary cardiac lymphoma is more frequent than primary cardiac lymphoma. CNHL often involves the right side of the heart. Diagnosis of CNHL can be suggested by echocardiography and magnetic resonance imaging. Cytological examination of pericardial fluid or histological of cardiac tissue is essential. The majority of cases are diffuse B-cell lymphoma. A prompt immediate diagnosis and early treatment are essential for better outcome. Management should be individualized and the most effective treatment is chemotherapy containing anthracycline variably combined with radiotherapy. A multidisciplinary approach is essential to the successful treatment of CNHL.
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Affiliation(s)
- I Tazi
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc.
| | - A Benmoussa
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc
| | - F Z Boufarissi
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc
| | - M Sifsalam
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc
| | - F Z Lahlimi
- Service d'hématologie clinique, faculté de médecine, université Cadi Ayyad, CHU Mohamed VI, Marrakech, Maroc
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31
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Predictive Value of Cardiac CTA, Cardiac MRI, and Transthoracic Echocardiography for Cardioembolic Stroke Recurrence. AJR Am J Roentgenol 2021; 217:336-346. [PMID: 32936016 DOI: 10.2214/ajr.20.23903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Transthoracic echocardiography (TTE) is the standard of care for initial evaluation of patients with suspected cardioembolic stroke. Although TTE is useful for assessing certain sources of cardiac emboli, its diagnostic capability is limited in the detection of other sources, including left atrial thrombus and aortic plaques. OBJECTIVE. The purpose of this article was to investigate sensitivity, specificity, and predictive value of cardiac CTA (CCTA), cardiac MRI (CMRI), and TTE for recurrence in patients with suspected cardioembolic stroke. METHODS. We retrospectively included 151 patients with suspected cardioembolic stroke who underwent TTE and either CMRI (n = 75) or CCTA (n = 76) between January 2013 and May 2017. We evaluated for the presence of left atrial thrombus, left ventricular thrombus, vulnerable aortic plaque, cardiac tumors, and valvular vegetation as causes of cardioembolic stroke. The end point was stroke recurrence. Sensitivity, specificity, PPV, and NPV for recurrent stroke were calculated; the diagnostic accuracy of CMRI, CCTA, and TTE was compared between and within groups using AUC. RESULTS. Twelve and 14 recurrent strokes occurred in the CCTA and CMRI groups, respectively. Sensitivity, specificity, PPV, and NPV were 33.3%, 93.7%, 50.0%, and 88.2% for CCTA; 14.3%, 80.3%, 14.3%, and 80.3% for CMRI; 14.3%, 83.6%, 16.7%, and 80.9% for TTE in the CMRI group; and 8.3%, 93.7%, 20.0%, and 84.5% for TTE in the CCTA group. Accuracy was not different (p > .05) between CCTA (AUC = 0.63; 95% CI, 0.49-0.77), CMRI (0.53; 95% CI, 0.42-0.63), TTE in the CMRI group (0.51; 95% CI, 0.40-0.61), and TTE in the CCTA group (0.51; 95% CI, 0.42-0.59). In the CCTA group, atrial and ventricular thrombus were detected by CCTA in three patients and TTE in one patient; in the CMRI group, thrombus was detected by CMRI in one patient and TTE in two patients. CONCLUSION. CCTA, CMRI, and TTE showed comparably high specificity and NPV for cardioembolic stroke recurrence. CCTA and CMRI may be valid alternatives to TTE. CCTA may be preferred given potentially better detection of atrial and ventricular thrombus. CLINICAL IMPACT. CCTA and CMRI have similar clinical performance as TTE for predicting cardioembolic stroke recurrence. This observation may be especially important when TTE provides equivocal findings.
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Chaosuwannakit N, Makarawate P. Left Ventricular Thrombi: Insights from Cardiac Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2021; 7:180-188. [PMID: 34065998 PMCID: PMC8162548 DOI: 10.3390/tomography7020016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
Objective: Cardiovascular magnetic resonance imaging (CMR) late gadolinium enhancement technique (LGE) detects thrombus rather than anatomical presence based on tissue properties and is theoretically highly accurate. The present study’s goal was to compare the diagnostic accuracy obtained with various CMR techniques and transthoracic echocardiography to diagnose left ventricular thrombus and evaluate the prevalence and perspectives of left ventricular (LV) thrombus among patients with impaired systolic left ventricular function. Methods: In a single academic referral center, a retrospective database review of all CMR assessments of the established left ventricular thrombus was carried out in 206 consecutive patients with reduced systolic function for five years. To assess thrombus risk factors, clinical and imaging parameters were analyzed. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), echocardiography, and cine-CMR sequence accuracy have been identified. LV structural parameters were quantified to detect markers for thrombus and predictors of the additive usefulness of contrast-enhanced thrombus imaging. Comparisons against LGE-CMR were made, which was used as the standard. Results: A 7.8 percent prevalence of left ventricular thrombus was identified by LGE-CMR. Cine-CMR increased the diagnostic efficiency for echocardiographic thrombus identification in this group, with sensitivity increasing from 50 percent by echocardiography to 75 percent by cine-CMR (p = 0.008). Dark blood CMR (DB-CMR) has better sensitivity and accuracy than echocardiography (p < 0.001), comparable to cine-CMR. The transmural infarct size was an independent marker for thrombus after correction for the LVEF and LV volume while considering only CMR parameters. There were significantly higher embolic events (HR = 71.33; CI 8.31–616.06, p < 0.0001) in LV thrombus patients detected by LGE-CMR. Conclusion: CMR imaging was more sensitive to left ventricular thrombi identification compared with transthoracic echocardiography. An additional parameter available from LGE-CMR and shown as an independent risk factor for left ventricular thrombus is the myocardial scar.
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Affiliation(s)
- Narumol Chaosuwannakit
- Radiology Department, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Correspondence:
| | - Pattarapong Makarawate
- Cardiology Unit, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
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33
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Spiliopoulos K, Anyfantakis ZA, Diminikos I, Xanthopoulos A, Magouliotis DE, Skoularigis J, Triposkiadis F. Acute myocardial infarction not attributed to coronary artery disease: A seldom initial presentation of a left ventricular myxoma. Clin Case Rep 2021; 9:e04029. [PMID: 34084484 PMCID: PMC8142312 DOI: 10.1002/ccr3.4029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/22/2021] [Accepted: 02/18/2021] [Indexed: 12/02/2022] Open
Abstract
Although myxoma represents the most frequent non-malignant cardiac primary tumor; it is extremely rare met in the left ventricle. Clinical features of the neoplasm extend from symptomless to critical signs of either ischemia or embolism. We describe here an unusual case of a huge left ventricular myxoma in a 68-year-old man, presented with clinical and ECG findings of an inferior wall myocardial infarction. The patient was primarily referred to our institution for coronary angiography, which showed no coronary artery disease. Further examinations revealed a left ventricular mass as the possible source of embolization, thus the patient underwent surgery for tumor excision. The postoperative course was unremarkable. A bibliographical analysis demonstrated that those tumors are rare but treatable causes of embolic myocardial infarction, thus profound clinical intuition, proper utilization of imaging modalities, administration of anticoagulants preoperatively, as well immediate surgical removal are justified.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular SurgeryFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Zacharias A. Anyfantakis
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Ilias Diminikos
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Andrew Xanthopoulos
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Dimitrios E. Magouliotis
- Department of SurgeryFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - John Skoularigis
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
| | - Filippos Triposkiadis
- Department of CardiologyFaculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissaGreece
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Dahiya A, Chao C, Younger J, Kar J, Baldwin BM, Cohen MV, Joseph S, Chowdhry A, Figarola MS, Malozzi C, Nasser MF, Nabeel Y, Shah R, Kennen JM, Aneja A, Khalil S, Ragab S, Mohammed O, Moustafa T, Hamdy A, Ahmed S, Heny A, Taher M, Ganigara M, Dhar A, Misra N, Alzubi J, Pannikottu K, Jabri A, Hedge V, Kanaa'n A, Lahorra J, de Waard D, Horne D, Dhillon S, Sweeney A, Hamilton-Craig C, Katikireddi VS, Wesley AJ, Hammet C, Johnson JN, Chen SSM. Society for Cardiovascular Magnetic Resonance 2019 Case of the Week series. J Cardiovasc Magn Reson 2021; 23:44. [PMID: 33794918 PMCID: PMC8015162 DOI: 10.1186/s12968-020-00671-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). The SCMR web site ( https://www.scmr.org ) hosts a case series designed to present case reports demonstrating the unique attributes of CMR in the diagnosis or management of cardiovascular disease. Each clinical presentation is followed by a brief discussion of the disease and unique role of CMR in disease diagnosis or management guidance. By nature, some of these are somewhat esoteric, but all are instructive. In this publication, we provide a digital archive of the 2019 Case of the Week series as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.
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Affiliation(s)
- Arun Dahiya
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Griffith University School of Medicine, Gold Coast, QLD, Australia
| | - Charles Chao
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - John Younger
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Julia Kar
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Bryant M Baldwin
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Michael V Cohen
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Shane Joseph
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Anam Chowdhry
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Maria S Figarola
- Department of Radiology, University of South Alabama, Mobile, AL, USA
| | | | - M Farhan Nasser
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Yassar Nabeel
- Department of Internal Medicine, Division of Cardiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Rajiv Shah
- Department of Radiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - J Michael Kennen
- Department of Radiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ashish Aneja
- Department of Internal Medicine, Division of Cardiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sameh Khalil
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Sara Ragab
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Omnia Mohammed
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Taher Moustafa
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Ahmed Hamdy
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Shimaa Ahmed
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Ahmed Heny
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Maha Taher
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Madhusudan Ganigara
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York-Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Arushi Dhar
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York-Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York-Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Jafar Alzubi
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Kurian Pannikottu
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ahmad Jabri
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Vinayak Hedge
- Department of Cardiology, Cleveland Clinic Akron General, Akron, OH, USA
| | - Anmar Kanaa'n
- Department of Cardiology, Cleveland Clinic Akron General, Akron, OH, USA
| | - Joseph Lahorra
- Department of Cardiothoracic Surgery, Cleveland Clinic Akron General, Akron, OH, USA
| | | | - David Horne
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Santokh Dhillon
- Isaac Walton Killam Children's Hospital, Halifax, NS, Canada
| | - Aoife Sweeney
- Department of Rheumatology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Christian Hamilton-Craig
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - V S Katikireddi
- Department of Rheumatology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Allan J Wesley
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Chris Hammet
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | - Sylvia S M Chen
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia.
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Alrehaili M, Tashkandi E. Diagnostic and Therapeutic Challenges Associated with the Rare Cardiac Metastasis Complicating Rectal Adenocarcinoma. Case Rep Oncol 2021; 13:1441-1445. [PMID: 33442368 PMCID: PMC7772863 DOI: 10.1159/000511600] [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: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in the world. It typically metastasizes to the lymph nodes, liver or lungs. Cardiac involvement is considered the least likely metastatic complication of malignant tumors including CRC. We report a rare case of metastatic rectal cancer to the liver, ovaries, lungs and peritoneum that presented initially with a 1-week history of rectal bleeding. Her hospital course was complicated by progressive dyspnea and palpitations secondary to right atrial metastasis based on imaging studies including cardiac MRI with contrast. The patient was not fit for chemotherapy or any surgical intervention given her poor prognosis and functional status in the setting of advanced stage of her disease. After discussion with the patient and her family, a decision was made to change her code status to DNR (do not resuscitate) and focus on palliative treatment of her disease. She expired about 2 weeks following her discharge date. Based on this case report, we recommend a high index of suspicion for cardiac metastasis when dealing with cardiac or respiratory complaints in cases of CRC that need careful evaluation with echocardiography and MRI.
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Affiliation(s)
- Mohammad Alrehaili
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Emad Tashkandi
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia.,College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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36
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Im J, Kim DS. Cardiac Papillary Fibroelastoma in Left Ventricular Trabeculation as a Potential Cause of Cerebral Infarction: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:988-993. [PMID: 36238051 PMCID: PMC9514417 DOI: 10.3348/jksr.2020.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/14/2020] [Accepted: 10/24/2020] [Indexed: 11/15/2022]
Abstract
Cardiac papillary fibroelastoma (CPF) is the second or third most common primary cardiac tumor. Although histologically benign, it can cause serious symptoms depending on its location of occurrence, size, and motility. Herein, we report CPF in the left ventricular trabeculation as a potential cause of cerebral infarction.
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Affiliation(s)
- JunYong Im
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Dong Su Kim
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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37
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Thyagarajan B, Bryant C, Khanna AK. An Incidental Finding of Coronary-cameral Fistulas in a Critically Ill Patient with a Metastatic Cardiac Tumor. Indian J Crit Care Med 2021; 25:340-342. [PMID: 33790519 PMCID: PMC7991753 DOI: 10.5005/jp-journals-10071-23768] [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: 11/23/2022] Open
Abstract
It is extremely rare for a cardiac tumor to present with coronary-cameral fistulas. A 66-year-old Caucasian male presented with worsening dyspnea and subsequently had a cardiac catheterization for an ST-elevation myocardial infarction, revealing no evidence of coronary artery disease but multiple coronary-cameral fistulas. Venoarterial (VA) extracorporeal membrane oxygenation was initiated for a severe cardiogenic shock. Workups including a transesophageal echocardiography and a right heart catheterization led to a diagnosis of metastatic melanoma involving both ventricles of his heart. Angiogenesis is well described in melanomas and our novel case reports the extremely rare association of coronary-cameral fistulas with a metastatic cardiac melanoma. How to cite this article: Thyagarajan B, Bryant C, Khanna AK. An Incidental Finding of Coronary-cameral Fistulas in a Critically Ill Patient with a Metastatic Cardiac Tumor. Indian J Crit Care Med 2021;25(3):340-342.
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Affiliation(s)
- Braghadheeswar Thyagarajan
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Casey Bryant
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States and Outcomes Research Consortium, Cleveland, OH, United States
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38
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Lim HJ, Kim SS, Ahn KT, Kim KH, Kim JH. Difficulties in Differentiating Cardiac Lymphoma and Metastasis Based on Radiologic Features: Two Case Reports. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1575-1580. [PMID: 36238881 PMCID: PMC9431987 DOI: 10.3348/jksr.2020.0196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
Cardiac tumors are rare diseases with various imaging findings. However, differentiating cardiac tumors based on imaging findings is challenging because of similarities in imaging features. We present two cases of cardiac tumors, including primary cardiac lymphoma and cardiac metastasis, in which the differential diagnosis was difficult.
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Affiliation(s)
- Hyun Jae Lim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kye Taek Ahn
- Department of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kun Ho Kim
- Department of Nuclear Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Hwan Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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39
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Zuwasti U, Quarrie R, Allen E, Haas C. Severe functional mitral stenosis due to a left atrial myxoma masquerading as asthma. BMJ Case Rep 2020; 13:13/12/e236876. [PMID: 33334748 PMCID: PMC7747612 DOI: 10.1136/bcr-2020-236876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
While cardiac myxomas are the most common primary cardiac tumours, their overall incidence remains rare. Most cases (90%) are sporadic and occur in the third–sixth decades of life with a female predominance and have a specific predilection for the left atrium (75%). While often asymptomatic, clinical presentations depend on the tumour size, architecture and location. Echocardiography remains the mainstay for diagnostic evaluation. Tumour resection is the only definitive treatment. Histopathology using H&E and immunohistochemical stains, such as calretinin and CD34, confirms the diagnosis. We present a case of a patient with reported history of asthma who presented with recurrent acute on chronic shortness of breath refractory to inhaler therapy, multiple outpatient visits and hospitalisations for ‘asthma exacerbations’. After further evaluation, she was diagnosed with a left atrial myxoma attached to the inferior aspect of the intra-atrial septum complicated by severe functional mitral stenosis.
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Affiliation(s)
- Ufara Zuwasti
- Department of Internal Medicine, MedStar Health, Baltimore, Maryland, USA
| | - Ricardo Quarrie
- Heart and Vascular Institute, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Elizabeth Allen
- Department of Pathology, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Christopher Haas
- Department of Internal Medicine, MedStar Harbor Hospital, Baltimore, Maryland, USA.,MedStar Franklin Square Medical Center, Baltimore, Maryland, USA
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40
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Aggeli C, Dimitroglou Y, Raftopoulos L, Sarri G, Mavrogeni S, Wong J, Tsiamis E, Tsioufis C. Cardiac Masses: The Role of Cardiovascular Imaging in the Differential Diagnosis. Diagnostics (Basel) 2020; 10:diagnostics10121088. [PMID: 33327646 PMCID: PMC7765127 DOI: 10.3390/diagnostics10121088] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic tumors. Given their diversity, there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. In the past, diagnosis used to be made by the histological specimens after surgery or during the post-mortem examination. Nevertheless, evolution and increased availability of cardiovascular imaging modalities has enabled better characterization of the masses and the surrounding tissue. Transthoracic echocardiography using contrast agents can evaluate the location, the morphology and the perfusion of the mass as well as its hemodynamic effect. Transesophageal echocardiography has increased spatial and temporal resolution; hence it is superior in depicting small highly mobile masses. Cardiac magnetic resonance and cardiac computed tomography are complementary providing tissue characterization. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account the epidemiology and clinical presentation of the cardiac masses, as well as the availability and the incremental value of each imaging modality.
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Affiliation(s)
- Constantina Aggeli
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
- Correspondence:
| | - Yannis Dimitroglou
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Leonidas Raftopoulos
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Georgia Sarri
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Sophie Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Centre, 17674 Kallithea, Attica, Greece;
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital and Royal Brompton Hospital, London UB96JH, UK;
| | - Eleftherios Tsiamis
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
| | - Costas Tsioufis
- First Department of Cardiology, General Hospital of Athens Hippokration, University of Athens Medical School, 11527 Athens, Attica, Greece; (Y.D.); (L.R.); (G.S.); (E.T.); (C.T.)
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Latifi AN, Ibe U, Arbune A, Kluger H, Baldassarre LA. Cardiac Biventricular Metastasis From Renal Cell Carcinoma. Cureus 2020; 12:e10870. [PMID: 33178523 PMCID: PMC7652367 DOI: 10.7759/cureus.10870] [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: 11/29/2022] Open
Abstract
Secondary cardiac tumors are much more common than primary tumors. Cardiac metastases from renal cell carcinoma (RCC) are rare and can present many years after the patient has been disease-free. We report the case of a 64-year-old man who had been treated for recurrent metastatic RCC. He presented with shortness of breath, and TEE (transthoracic echocardiography) revealed new biventricular hypertrophy and small-to-moderate circumferential pericardial effusion. Cardiac magnetic resonance demonstrated multiple lesions in both the ventricular walls, highly suspicious for metastasis. A tissue biopsy was obtained, which was inconclusive due to the small sample size. The patient's disease progressively worsened, and, subsequently, he died from cardiac and respiratory failure secondary to the underlying advanced metastatic disease. Cardiac metastasis from RCC is rare and has a wide range of presentations. Metastatic RCC tends to be resistant to chemotherapy and radiotherapy. Systemic therapy (immunotherapy, molecularly targeted agents) and surgery may have a role in these patients depending on the extent of disease and sites of involvement.
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Affiliation(s)
| | | | - Amit Arbune
- Cardiology, Yale School of Medicine, New Haven, USA
| | - Harriet Kluger
- Hematology and Oncology, Yale New Haven Hospital, New Haven, USA
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Role of cardiovascular magnetic resonance in an adolescent with a giant intrapericardial mass. Cardiol Young 2020; 30:1524-1526. [PMID: 32778186 DOI: 10.1017/s1047951120002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 14 -year-old boy presented with chest pain and breathlessness. Echocardiography showed a large pericardial effusion with cardiac tamponade features and suspicion of cardiac mass. Cardiovascular magnetic resonance demonstrated a large, well-defined pericardial mass, suggesting atypical large coronary fistula with pericardial haematoma or primary cardiac/pericardial tumour such as angiosarcoma. Histology confirmed a mixed-type vascular malformation. Sirolimus therapy was initiated.
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Joshi M, Kumar S, Noshirwani A, Harky A. The Current Management of Cardiac Tumours: a Comprehensive Literature Review. Braz J Cardiovasc Surg 2020; 35:770-780. [PMID: 33118743 PMCID: PMC7598975 DOI: 10.21470/1678-9741-2019-0199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To understand the current evidence and guidelines behind the appropriate management of cardiac tumours. METHODS A comprehensive electronic literature search has been performed in major databases - PubMed, Embase, Scopus, Ovid, and Google Scholar. All articles that discussed all different forms of cardiac tumours, their clinical presentation, diagnosis, and management methods have been critically appraised in this narrative review. RESULTS All relevant studies have been summarized in appropriate sections within our review. Cardiac tumours are rare but can be catastrophic and life-threatening if not identified and managed on timely manner. Utilization of all the available imaging methods can be of equivocal importance, relevant to each cardiac tumour. Surgical excision is the ultimate treatment method, however histopathological results can guide the adjunct treatment. CONCLUSION Early detection of cardiac tumours has significant effect on planning the method of intervention. Technological advancements and increased availability of imaging modalities have enabled earlier and more accurate detection of these tumours. Novel medical therapies, recommendations for screening, and operative techniques have all contributed to overall improving knowledge of these tumours and ultimately patient outcomes.
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Affiliation(s)
- Mihika Joshi
- Countess of Chester Hospital Chester United Kingdom Countess of Chester Hospital, Chester, United Kingdom
| | - Siddhant Kumar
- Aintree University Hospital Liverpool United Kingdom Aintree University Hospital, Liverpool, United Kingdom
| | - Arish Noshirwani
- Countess of Chester Hospital Chester United Kingdom Countess of Chester Hospital, Chester, United Kingdom
| | - Amer Harky
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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Kimura A, Kanzaki H, Izumi C. A case report of primary cardiac fibroma: an effective approach for diagnosis and therapy of a pathologically benign tumour with an unfavourable prognosis. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32974467 DOI: 10.1093/ehjcr/ytaa186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 03/31/2020] [Accepted: 05/29/2020] [Indexed: 11/12/2022]
Abstract
Background Primary cardiac fibroma is exceedingly rare. This condition involves a significant risk of life-threatening arrhythmias during follow-up and its prognosis is not as favourable as other benign tumours. We report a case of cardiac fibroma that was preoperatively diagnosed with echocardiography and magnetic resonance imaging. This fibroma was excised early as a preventative measure to avoid sudden death. Case summary A 46-year-old woman presented to our hospital with a 1-year history of chest tightness at rest. Echocardiography showed a large, isoechoic, well-circumscribed mass within the left ventricular myocardium with calcified tissue. Magnetic resonance imaging showed an intramural ventricular mass with iso signal intensity on T1-weighted imaging and low-signal intensity on T2-weighted imaging. There was no enhancement on first-pass perfusion imaging and homogeneous hyperenhancement on late gadolinium enhancement imaging. These features suggested a diagnosis of cardiac fibroma. Complete resection was performed to avoid sudden death and pathological analysis confirmed the tumour as cardiac fibroma. The patient was discharged 9 days after surgery and remains disease-free 5 months after surgery. Discussion Cardiac fibroma is a pathologically benign tumour with an unfavourable prognosis because of lethal arrhythmias, which can be controlled by its resection. Thus, it is important to preoperatively distinguish cardiac fibroma from other benign tumours, in order to prioritize surgical intervention for those with cardiac fibromas. Preoperative diagnosis with echocardiography and magnetic resonance imaging and early preventative surgery are the keys to improve prognosis of patients with cardiac fibromas.
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Affiliation(s)
- Akihisa Kimura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
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Sultan FAT, Ahmed SW. Cardiac Magnetic Resonance Evaluation of Cardiac Masses in Patients with Suspicion of Cardiac Masses on Echo or Computed Tomography. J Clin Imaging Sci 2020; 10:57. [PMID: 33024612 PMCID: PMC7533085 DOI: 10.25259/jcis_137_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/30/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: In recent years, cardiac magnetic resonance (CMR) imaging has emerged as an important tool in the identification and characterization of cardiac masses. No imaging data on cardiac masses are available from Pakistan. We aimed to review the clinical presentation, CMR findings, and outcome of patients referred for CMR due to suspicion of cardiac masses on echocardiogram or computed tomography (CT). Material and Methods: We reviewed all the patients referred for CMR at Aga Khan University Hospital, Karachi, from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Only those with the confirmed diagnosis of cardiac mass on CMR were included in the study. Results: A total of 27 patients were referred for CMR from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Four patients were excluded as no cardiac mass was found on CMR. Out of 23 cases, majority (n = 15, 65%) were female, age ranging from 3 months to 70 years, with a mean age of 40 ± 22 years. Shortness of breath was the main presenting symptom (n = 19, 83%). Echocardiogram was the initial imaging modality done in all the patients while CT was also performed in 6 patients (26%). Out of 23 patients, 4 (17%) were diagnosed to have thrombus on CMR. In two cases, it was in the left ventricle with evidence of myocardial infarction on late gadolinium images. Myxoma was the most common tumor diagnosed on CMR in 6 patients (26%) followed by rhabdomyoma (n = 3, 13%) and fibroma (n = 2, 8.7%). There were three malignant primary tumors of the heart based on CMR appearances and one with tumor thrombus extension of hepatocellular carcinoma in the right atrium from inferior vena cava. Two patients were diagnosed to have non-neoplastic lesions – one with large intracardiac hydatid cyst and one with possible large fungal vegetation. Among 23 patients, 9 patients (39%) underwent surgery, 5 with myxoma, 2 with rhabdomyoma, 1 with fibroma, and 1 with fibroelastoma. Findings on surgery and histopathology matched the CMR diagnosis in all the patients except the one with the CMR diagnosis of myxoma in which histopathology was consistent with thrombus. Conclusion: CMR can play an important role in confirming the presence or absence of a mass in the heart. It can also provide differentiation of non-neoplastic and neoplastic lesions and among different types of neoplastic lesions with reasonable accuracy. However, the limitations of CMR must be recognized.
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Affiliation(s)
- Fateh Ali Tipoo Sultan
- Department of Medicine (Cardiology), Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Syed Waqar Ahmed
- Department of Medicine (Cardiology), Aga Khan University Hospital, Karachi, Sindh, Pakistan
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Maia Alves R, Gamboa C. Cardiac Lipoma of the Interventricular Septum. Eur J Case Rep Intern Med 2020; 7:001685. [PMID: 32908825 DOI: 10.12890/2020_001685] [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: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 11/05/2022] Open
Abstract
Cardiac lipomas are rare benign primary neoplasms of the heart, usually found incidentally, that can become symptomatic depending on their size and location. We report the case of a 61-year-old man presenting with chest pain and elevated troponin and a normal EKG and D-dimers. A transthoracic echocardiogram revealed an intracardiac mass attached to the interventricular septum protruding to the left ventricle, later confirmed to be a lipomatous mass consistent with a cardiac lipoma on cardiac magnetic resonance imaging. Due to the mass characteristics and favourable evolution, it was decided not to excise the tumour, and the patient remains asymptomatic after a 4-year follow-up period. LEARNING POINTS Cardiac lipomas are rare benign tumours, usually found incidentally, although they can cause a wide array of symptoms depending on their size and location.Cardiac magnetic resonance imaging is the most accurate diagnostic method to characterize lipomatous cardiac masses and to distinguish lipomas from liposarcomas.Surgical excision is the mainstay of the treatment when feasible, although small asymptomatic lipomas can be managed with a vigilant non-invasive approach.
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Affiliation(s)
- Rodrigo Maia Alves
- Medicine Department, Internal Medicine Service, Hospital Sousa Martins, Guarda, Portugal
| | - Cristina Gamboa
- Medicine Department, Cardiology Service, Hospital Sousa Martins, Guarda, Portugal
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Raza M, Ikram S, Williams N, Otero D, Barry N, Kelsey N, Kahlon T, Singh V. Cardiac Lymphoma Presenting with Recurrent STEMI. Methodist Debakey Cardiovasc J 2020; 16:158-161. [PMID: 32670477 DOI: 10.14797/mdcj-16-2-158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The incidence of primary cardiac tumors is exceedingly rare, whereas secondary cardiac tumors are more common in the global population. Cardiac involvement is seen in approximately 18% of patients with non-Hodgkin's lymphoma at the time of autopsy. Clinical manifestations of cardiac involvement are subtle and often go unrecognized until advanced stages of the disease. We present a rare case of metastatic cardiac lymphoma that presented as an ST-segment elevation myocardial infarction complicated by left ventricular free wall rupture and cardiogenic shock due to transmural myocardial necrosis from malignant cell infiltration.
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Affiliation(s)
- Munis Raza
- UNIVERSITY OF LOUISVILLE, LOUISVILLE, KENTUCKY
| | | | | | - Diana Otero
- UNIVERSITY OF LOUISVILLE, LOUISVILLE, KENTUCKY
| | - Neil Barry
- UNIVERSITY OF LOUISVILLE, LOUISVILLE, KENTUCKY
| | | | | | - Vikas Singh
- UNIVERSITY OF LOUISVILLE, LOUISVILLE, KENTUCKY
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48
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Cardiac magnetic resonance imaging and computed tomography for the pediatric cardiologist. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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49
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Tyebally S, Chen D, Bhattacharyya S, Mughrabi A, Hussain Z, Manisty C, Westwood M, Ghosh AK, Guha A. Cardiac Tumors: JACC CardioOncology State-of-the-Art Review. JACC: CARDIOONCOLOGY 2020; 2:293-311. [PMID: 34396236 PMCID: PMC8352246 DOI: 10.1016/j.jaccao.2020.05.009] [Citation(s) in RCA: 209] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl’s excrescences, and pericardial cyst). The advent of multimodality imaging has enabled identification of the etiology of cardiac masses in many cases, especially in conjunction with information from clinical settings. This paper provides a comprehensive review of the epidemiology, clinical presentation, imaging, diagnosis, management, and outcomes of cardiac masses. Cardiac tumors are rare and should be considered as part of the differential diagnosis of any space-occupying mass noted on cardiovascular and/or thoracic imaging modalities. It may be possible to get close to a diagnosis without biopsy using a structured imaging approach. The prognosis and treatment of each tumor is different, although early diagnosis is usually associated with a better outcome.
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Affiliation(s)
- Sara Tyebally
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Daniel Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Sanjeev Bhattacharyya
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Abdallah Mughrabi
- Jordan University of Science and Technology, Al Ramtha, Irbid, Jordan
| | - Zeeshan Hussain
- Division of Cardiology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Charlotte Manisty
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Mark Westwood
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
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50
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McAllister BJ. Multi Modality Imaging Features of Cardiac Myxoma. J Cardiovasc Imaging 2020; 28:235-243. [PMID: 32462832 PMCID: PMC7572253 DOI: 10.4250/jcvi.2020.0027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/10/2020] [Accepted: 04/24/2020] [Indexed: 11/29/2022] Open
Abstract
Primary cardiac neoplasms are rare entities of which approximately 75% are benign and the remaining 25% malignant. Myxomas are the most common benign primary cardiac tumor (30%) and most commonly arise in the left atrium from the interatrial septum at the fossa ovalis. However, they also can originate in any cardiac chamber. Clinical presentation and patient symptomatology are determined by size, location, and mobility of the myxoma. This review will discuss the clinical presentation, natural history, pathology, and multimodality imaging features of cardiac myxomas.
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Affiliation(s)
- Brylie J McAllister
- Department of Radiology, Gold Coast University Hospital, Southport, QLD, Australia.
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