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Tian Y, Lin J, Yang X, Zeng D, Hu Y, Chen J, Wu Z, Deng X. A rare morphology of the cardiac fibroma in a child: a case report. Front Cardiovasc Med 2024; 11:1357747. [PMID: 38606376 PMCID: PMC11008678 DOI: 10.3389/fcvm.2024.1357747] [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: 12/18/2023] [Accepted: 03/08/2024] [Indexed: 04/13/2024] Open
Abstract
Here we report a rare morphology of a cardiac fibroma in a child. A 2-year and 8-month-old toddler came for "chronic constipation" and was found to have a heart murmur on cardiac auscultation. Further transthoracic echocardiography suggested "a strong echogenic mass in the left ventricular wall, with some part of "a string of beads" in shape extending into left ventricle outflow tract", which was atypical for either a tumor, thrombus or vegetation. The child underwent resection of the mass and mitral valvuloplasty. Pathological examination confirmed the mass as a cardiac fibroma.
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Affiliation(s)
- Yunfei Tian
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jiayi Lin
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaohui Yang
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Debin Zeng
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yuan Hu
- Department of Echocardiography and Ultrasound, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jingnan Chen
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhongshi Wu
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xicheng Deng
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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2
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Yoshida T, Doi S, Kida K, Izumo M. Detection of left main coronary trunk occlusion due to prosthetic aortic valve endocarditis using transoesophageal echocardiography. BMJ Case Rep 2024; 17:e258734. [PMID: 38286580 PMCID: PMC10826529 DOI: 10.1136/bcr-2023-258734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Affiliation(s)
- Toshiya Yoshida
- Department of Cardiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shunichi Doi
- Department of Cardiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Keisuke Kida
- Department of Pharmacology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masaki Izumo
- Department of Cardiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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3
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Alerhand S, Adrian RJ. What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension? Am J Emerg Med 2023; 72:72-84. [PMID: 37499553 DOI: 10.1016/j.ajem.2023.07.011] [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: 05/08/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) and pulmonary hypertension (PH) are potentially fatal disease states. Early diagnosis and goal-directed management improve outcomes and survival. Both conditions share several echocardiographic findings of right ventricular dysfunction. This can inadvertently lead to incorrect diagnosis, inappropriate and potentially harmful management, and delay in time-sensitive therapies. Fortunately, bedside echocardiography imparts a few critical distinctions. OBJECTIVE This narrative review describes eight physiologically interdependent echocardiographic parameters that help distinguish acute PE and chronic PH. The manuscript details each finding along with associated pathophysiology and summarization of the literature evaluating diagnostic utility. This guide then provides pearls and pitfalls with high-quality media for the bedside evaluation. DISCUSSION The echocardiographic parameters suggesting acute or chronic right ventricular dysfunction (best used in combination) are: 1. Right heart thrombus (acute PE) 2. Right ventricular free wall thickness (acute ≤ 5 mm, chronic > 5 mm) 3. Tricuspid regurgitation pressure gradient (acute ≤ 46 mmHg, chronic > 46 mmHg, corresponding to tricuspid regurgitation maximal velocity ≤ 3.4 m/sec and > 3.4 m/sec, respectively) 4. Pulmonary artery acceleration time (acute ≤ 60-80 msec, chronic < 105 msec) 5. 60/60 sign (acute) 6. Pulmonary artery early-systolic notching (proximally-located, higher-risk PE) 7. McConnell's sign (acute) 8. Right atrial enlargement (equal to left atrial size suggests acute, greater than left atrial size suggests chronic). CONCLUSIONS Emergency physicians must appreciate the echocardiographic findings and associated pathophysiology that help distinguish acute and chronic right ventricular dysfunction. In the proper clinical context, these findings can point towards PE or PH, thereby leading to earlier goal-directed management.
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Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Robert James Adrian
- Department of Emergency Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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4
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Sahebjam M, Asl Fallah S, Ayati A, Farmanesh M. Papillary Muscle Lipoma in a Teenage Patient With Review of the Literature. CASE (PHILADELPHIA, PA.) 2023; 7:316-320. [PMID: 37614694 PMCID: PMC10442363 DOI: 10.1016/j.case.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
•Cardiac lipoma is exceedingly rare in both adult and pediatric populations. •Only a few cases of papillary muscle lipoma have been reported. •TTE is the first step in detecting a cardiac mass. •CMR contributes to the diagnosis of cardiac lipoma. •There are no specific guidelines for the treatment of papillary muscle lipoma.
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Affiliation(s)
- Mohammad Sahebjam
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Asl Fallah
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahkameh Farmanesh
- Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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5
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Abbass M, Mariani S, Musa S, Erba N, Masini F, Lentini S. Case Report: Right atrial organized thrombus three years after tricuspid annuloplasty. F1000Res 2023; 12:6. [PMID: 37359783 PMCID: PMC10285360 DOI: 10.12688/f1000research.129157.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Background: Occurrence of right atrial masses, especially in patients with history of cardiac surgery, is rare. Differential diagnosis between malignant and non-malignant aetiologies might be cumbersome, and surgery is often required to prevent complications or disease evolution. Case: We report the case of a 16-year-old girl from a rural area of Sudan, who underwent surgery for a modified De Vega's tricuspid annuloplasty, and mitral and aortic valve replacement with mechanical prostheses. The patient was on regular follow-up but demonstrated a poor compliance to anticoagulation therapy with a time in therapeutic range between 52% and 20%. She remained asymptomatic, but a right atrial mass was diagnosed by transthoracic echocardiography during a follow-up visit 41 months after the first operation. Surgical removal of the mass revealed an organized thrombus arising from the point where the Prolene stitches for the tricuspid annuloplasty were previously passed. The patient recovered from surgery, was discharged home on post-operative day 10 and the first follow-up visit at 30 days after discharge confirmed a good clinical status and a normal transthoracic echocardiography (TTE). Conclusions: This case report describes the diagnostic and therapeutic work-out of a thrombus formation on the suture lines of a tricuspid annuloplasty. Moreover, it highlights the importance of a strict and long follow-up after valvular surgery and of the adherence to anticoagulation therapy, especially for patients living in rural areas of developing countries.
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Affiliation(s)
- Mohannad Abbass
- Salam Centre for Cardiac Surgery, EMERCENCY ONG ONLUS, Khartoum, Sudan
| | - Silvia Mariani
- Salam Centre for Cardiac Surgery, EMERCENCY ONG ONLUS, Khartoum, Sudan
| | - Sami Musa
- Salam Centre for Cardiac Surgery, EMERCENCY ONG ONLUS, Khartoum, Sudan
| | - Nicoletta Erba
- Salam Centre for Cardiac Surgery, EMERCENCY ONG ONLUS, Khartoum, Sudan
| | - Franco Masini
- Salam Centre for Cardiac Surgery, EMERCENCY ONG ONLUS, Khartoum, Sudan
| | - Salvatore Lentini
- Salam Centre for Cardiac Surgery, EMERCENCY ONG ONLUS, Khartoum, Sudan
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6
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Mastrangelo A, Olivares P, Giambuzzi I, Muratori M, Alamanni F, Bartorelli AL. Diagnosis and treatment of a left atrial myxoma originating from an atrial septal defect closure device: a case report. Eur Heart J Case Rep 2023; 7:ytad258. [PMID: 37323531 PMCID: PMC10267617 DOI: 10.1093/ehjcr/ytad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/01/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
Background Ostium secundum atrial septal defect (osASD) is a common congenital heart disease and transcatheter closure is the preferred treatment. Late device-related complications include thrombosis and infective endocarditis (IE). Cardiac tumours are exceedingly rare. The aetiology of a mass attached to an osASD closure device can be challenging to diagnose. Case summary A 74-year-old man with atrial fibrillation was hospitalized for evaluating a left atrial mass discovered incidentally 4 months earlier. The mass was attached to the left disc of an osASD closure device implanted 3 years before. No shrinkage of the mass was observed despite optimal intensity of anticoagulation. We describe the diagnostic workup and management of the mass that at surgery turned out to be a myxoma. Discussion A left atrial mass attached to an osASD closure device raises the suspect of device-related complications. Poor endothelialisation may promote device thrombosis or IE. Cardiac tumours (CT) are rare, and myxoma is the most common primary CT in adults. Although no clear relationship exists between the implantation of an osASD closure device and a myxoma, the development of this tumour is a possible occurrence. Echocardiography and cardiovascular magnetic resonance play a key role in the differential diagnosis between a thrombus and a myxoma, usually identifying distinctive mass features. Nevertheless, sometimes non-invasive imaging may be inconclusive, and surgery is necessary to make a definitive diagnosis.
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Affiliation(s)
| | - Paolo Olivares
- Department of Interventional Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Carlo Parea 4, 20138 Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Carlo Parea 4, 20138 Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Via Carlo Parea 4, 20138 Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Istituto Clinico Sant’Ambrogio, Via Privata Val Vigezzo 5, 20149 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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7
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Șerban A, Dădârlat-Pop A, Tomoaia R, Trifan C, Molnar A, Manole S, Achim A, Suceveanu M. The Role of Multimodality Imaging in the Diagnosis and Follow-Up of Malignant Primary Cardiac Tumors: Myxofibrosarcoma-A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:diagnostics13101811. [PMID: 37238295 DOI: 10.3390/diagnostics13101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Cardiac tumors are a very rare but heterogenous group of diseases that may reveal themselves through a variety of nonspecific cardiac symptoms that may pose a challenge to the diagnostic process. Myxofibrosarcoma is a particularly rare type of cardiac tumor that carries a poor prognosis, thus making accurate and timely diagnosis essential. A 61-year-old woman presented with fatigue and shortness of breath during mild exercise, symptoms that have progressively worsened during the previous year. Multimodality imaging consisting of transthoracic and transesophageal echocardiography (TTE and TEE), cardiac magnetic resonance (CMR), cardiac computer tomography (CCT), and fluorodeoxyglucose positron emission computer tomography (18F-FDG PET-CT) was used for the diagnosis and postoperative follow-up of a myxofibrosarcoma.
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Affiliation(s)
- Adela Șerban
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Alexandra Dădârlat-Pop
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Raluca Tomoaia
- 5th Department of Internal Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Clinical Rehabilitation Hospital, 46-50 Viilor Street, 400347 Cluj-Napoca, Romania
| | - Cătălin Trifan
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Adrian Molnar
- Cardiovascular Surgery Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Simona Manole
- Radiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Alexandru Achim
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
| | - Mihai Suceveanu
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
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8
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QUAH KHK, FOO JS, KOH CH. Approach to Cardiac Masses Using Multimodal Cardiac Imaging. Curr Probl Cardiol 2023; 48:101731. [PMID: 37030421 DOI: 10.1016/j.cpcardiol.2023.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
Incidental cardiac masses can pose diagnostic challenges given the numerous differentials, and difficulty in obtaining tissue confirmation without invasive procedures. With recent advancements in cardiac imaging technology, non-invasive efforts to diagnose the intracardiac lesions have become more surmountable. In this paper, we report a case of a patient incidentally found to have an intra-cardiac mass during routine evaluation. Transthoracic echocardiography demonstrated a small mass attached to the tricuspid valve, which was not visualized on follow up cardiac magnetic resonance imaging. Here, we review the currently available cardiac imaging modalities and discuss their values and limitations. From this, we also propose a workflow in the approach to utilizing different imaging modalities to reach a conclusive diagnosis of undifferentiated cardiac masses.
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9
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Fioretti AM, Leopizzi T, La Forgia D, Scicchitano P, Oreste D, Fanizzi A, Massafra R, Oliva S. Incidental right atrial mass in a patient with secondary pancreatic cancer: A case report and review of literature. World J Clin Cases 2023; 11:1206-1216. [PMID: 36874413 PMCID: PMC9979295 DOI: 10.12998/wjcc.v11.i5.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/30/2022] [Accepted: 01/10/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND The incidental detection of a right atrial mass during routine cardioncological workup is a rare condition. The correct differential diagnosis between cancer and thrombi is challenging. A biopsy may not be feasible while diagnostic techniques and tools may not be available.
CASE SUMMARY We report the case of a 59-year-old female patient with a history of breast cancer and current secondary metastatic pancreatic cancer. She developed deep vein thrombosis and pulmonary embolism and was admitted to the Outpatient Clinic of our Cardio-Oncology Unit for follow-up. Transthoracic echocardiogram incidentally found a right atrial mass. Clinical management was difficult due to the abrupt worsening of the patient’s clinical condition and the progressive severe thrombocytopenia. We suspected a thrombus, according to its echocardiographic appearance, the patient’s cancer history and recent venous thromboembolism. The patient was unable to adhere to low molecular weight heparin treatment. Due to worsening prognosis, palliative care was recommended. We also highlighted the distinguishing features between thrombi and tumors. We proposed a diagnostic flowchart to aid diagnostic decision making in the case of an incidental atrial mass.
CONCLUSION This case report highlights the importance of cardioncological surveillance during anticancer treatments to detect cardiac masses.
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Affiliation(s)
| | - Tiziana Leopizzi
- Cardiology and Intensive Care Unit, Ospedale SS. Annunziata, Taranto 74121, Italy
| | - Daniele La Forgia
- Department of Radiology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Pietro Scicchitano
- Cardiology and Intensive Care Unit, Ospedale “Fabio Perinei”, Altamura (Bari) 70022, Italy
| | - Donato Oreste
- Department of Radiology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Annarita Fanizzi
- Department of Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Raffaella Massafra
- Department of Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
| | - Stefano Oliva
- Cardio-Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari 70124, Italy
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10
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Borizanova A, Kinova E, Getsov P, Peichinov D, Goudev A. Hiatal Hernia: The Great Masquerade in the Emergency Department. Eur J Case Rep Intern Med 2023; 10:003834. [PMID: 37051480 PMCID: PMC10084805 DOI: 10.12890/2023_003834] [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: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 04/14/2023] Open
Abstract
Chest pain and dyspnoea are among the most common complaints seen in the emergency room and each symptom calls for a broad differential diagnosis. Large hiatal hernias are infrequent, but they can lead to atypical symptoms mimicking different cardiovascular, pulmonary and neoplastic diseases. We present two cases of older patients with an apparent left atrial mass on transthoracic echocardiography, which was subsequently identified as hiatal hernia by other imaging modalities. A multidisciplinary team with multimodality imaging is necessary for diagnostic work-up of chest pain and dyspnoea of non-cardiac origin and especially for a suspected mass compressing the heart, causing chest discomfort. LEARNING POINTS Hiatal hernia (HH) can mimic different cardiovascular, pulmonary and neoplastic diseases.HH has a typical echocardiographic (2DE) presentation as an amorphous, echolucent mass with the appearance of a left atrial space-occupying lesion.Oral ingestion of a carbonated drink may help to distinguish between a large HH and an atrial mass by 2DE.
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Affiliation(s)
- Angelina Borizanova
- Department of Emergency medicine, Medical university Sofia, Bulgaria
- Clinic of Cardiology, UMHAT “Tsaritsa Yoanna - ISUL” Sofia, Bulgaria
| | - Elena Kinova
- Department of Emergency medicine, Medical university Sofia, Bulgaria
- Clinic of Cardiology, UMHAT “Tsaritsa Yoanna - ISUL” Sofia, Bulgaria
| | - Plamen Getsov
- Department of Imaging diagnostics, Medical university Sofia, Bulgaria
| | - Dimitar Peichinov
- Department of Emergency medicine, Medical university Sofia, Bulgaria
- Surgery clinic, UMHAT “Tsaritsa Yoanna - ISUL” Sofia, Bulgaria
| | - Assen Goudev
- Department of Emergency medicine, Medical university Sofia, Bulgaria
- Clinic of Cardiology, UMHAT “Tsaritsa Yoanna - ISUL” Sofia, Bulgaria
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11
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Montoya-Beltran JS, Herrera LR, Marín PO, Navajas AN, Manrique Espinel FT. Atrial Fusocellular Sarcoma: An Uncommon Presentation. CASE 2023; 7:105-108. [PMID: 37065836 PMCID: PMC10103005 DOI: 10.1016/j.case.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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12
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A rare case of left atrial myxofibromyosarcoma. Radiol Case Rep 2022; 18:771-774. [PMID: 36589498 PMCID: PMC9794883 DOI: 10.1016/j.radcr.2022.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Myxofibrosarcoma is an aggressive soft tissue sarcoma, previously known as myxoid variant of malignant fibrous histiocytoma. Primary cardiac myxofibrosarcomas are the rarest forms of cardiac malignant tumors that often remain asymptomatic until metastasis occurs. In this case report, we describe a rare left atrial cardiac myxofibrosarcoma in a patient with recurrent renal cell carcinoma. We discuss the multimodality imaging approach to diagnose and evaluate cardiac masses as well as imaging characteristics to differentiate cardiac masses from thrombus.
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13
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Jiang R, Kushneriuk D, Chiu MH. Metastatic Melanoma Extending along the Pulmonary Vein into the Left Atrium: A Rare Route of Metastasis Characterized by Transesophageal Echocardiography. CASE 2022; 6:309-314. [PMID: 36172478 PMCID: PMC9510622 DOI: 10.1016/j.case.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Melanoma commonly metastasizes to the heart through hematogenous spread. These metastases can resemble benign cardiac tumors. Isolated left-sided cardiac involvement is rare with metastatic melanoma. Metastasis can atypically take a course through the pulmonary vein. Multimodality imaging is useful for characterization of these intracardiac masses.
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Affiliation(s)
- River Jiang
- Division of Cardiology, Gordon and Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominique Kushneriuk
- Division of Cardiology, Gordon and Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael H. Chiu
- Division of Cardiology, Gordon and Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Cardiology and Critical Care, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Correspondence: Michael H. Chiu, MD, Division of Cardiology, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada
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14
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Adali MK, Buber I. Concomitant Multiple Coronary Artery Embolizations and Bilateral Lower Limb Ischemia due to Dislodged Left Atrial Myxoma-Like Thrombus. J Cardiovasc Echogr 2022; 32:172-174. [PMID: 36619778 PMCID: PMC9819609 DOI: 10.4103/jcecho.jcecho_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/17/2022] [Indexed: 01/10/2023] Open
Abstract
The differential diagnosis of intracardiac masses is challenging. Cardiac myxomas are benign primary heart tumors and most often are confused with thrombi in diagnosis. In some cases, the embolic complication of intracardiac masses can be fatal. We present a patient who had two nightmare complications simultaneously. A mobile left atrial mass detected and decided surgical excision. But the mass had vanished one day after and caused ST-elevation myocardial infarction (STEMI) and bilateral lower limb ischemia.
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Affiliation(s)
- Mehmet Koray Adali
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ipek Buber
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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15
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Colangelo T, Peters P, Sadler M, Safi LM. Membranous Ventricular Septal Aneurysm Leading to Embolic Stroke. CASE 2022; 6:142-145. [PMID: 35602978 PMCID: PMC9120855 DOI: 10.1016/j.case.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
TTE is often ordered to assess for a cardiac source of emboli after an acute stroke. MVSAs may lead to blood stasis and thrombus formation. Color Doppler and UEAs may be used to confirm or exclude the presence of thrombus.
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16
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Gatti M, D’Angelo T, Muscogiuri G, Dell'aversana S, Andreis A, Carisio A, Darvizeh F, Tore D, Pontone G, Faletti R. Cardiovascular magnetic resonance of cardiac tumors and masses. World J Cardiol 2021; 13:628-649. [PMID: 34909128 PMCID: PMC8641001 DOI: 10.4330/wjc.v13.i11.628] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/19/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac masses diagnosis and treatment are a true challenge, although they are infrequently encountered in clinical practice. They encompass a broad set of lesions that include neoplastic (primary and secondary), non-neoplastic masses and pseudomasses. The clinical presentation of cardiac tumors is highly variable and depends on several factors such as size, location, relation with other structures and mobility. The presumptive diagnosis is made based on a preliminary non-invasive diagnostic work-up due to technical difficulties and risks associated with biopsy, which is still the diagnostic gold standard. The findings should always be interpreted in the clinical context to avoid misdiagnosis, particularly in specific conditions (e.g., infective endocarditis or thrombi). The modern multi-modality imaging techniques has a key role not only for the initial assessment and differential diagnosis but also for management and surveillance of the cardiac masses. Cardiovascular magnetic resonance (CMR) allows an optimal non-invasive localization of the lesion, providing multiplanar information on its relation to surrounding structures. Moreover, with the additional feature of tissue characterization, CMR can be highly effective to distinguish pseudomasses from masses, as well as benign from malignant lesions, with further differential diagnosis of the latter. Although histopathological assessment is important to make a definitive diagnosis, CMR plays a key role in the diagnosis of suspected cardiac masses with a great impact on patient management. This literature review aims to provide a comprehensive overview of cardiac masses, from clinical and imaging protocol to pathological findings.
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Affiliation(s)
- Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Tommaso D’Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, “G. Martino” University Hospital Messina, Messina 98100, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan 20149, Italy
| | | | | | - Andrea Carisio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Italy
| | - Davide Tore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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17
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Okan T, Babliak O, Agarwal K, Kuzyk Y, Lanka SP, Iskander B, Sharma S, Tadepalli S, Jaiswal R, Hussain A, Rashid MY, Chakinala RC. Asymptomatic Left Atrial Myxoma Treated With Minimally Invasive Surgical Approach. Cureus 2021; 13:e18432. [PMID: 34737901 PMCID: PMC8559889 DOI: 10.7759/cureus.18432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Myxomas, being the most common primary benign tumor among all cardiac tumors, occur rarely with a very low incidence rate. Myxomas can cause various clinical manifestations or can be diagnosed incidentally. Some patients with cardiac myxomas are completely asymptomatic. Cardiac myxomas cause life-threatening complications, thus early diagnosis is imperative. We are reporting a case of atrial myxoma in a 38-year-old female without any significant past medical history, who came to our clinic for cardiology evaluation prior to plastic surgery. The elliptical mobile mass, located in the left atrium with its attachment to the interatrial septum, was diagnosed by transthoracic echocardiography. The patient was referred for surgery and a minimally invasive surgical approach was chosen. A histological report confirmed the diagnosis of myxoma. The patient recovered well. Three years of follow-up did not reveal any signs of recurrence of the tumor. We are also analyzing 20 previously published cases of asymptomatic myxomas and myxomas treated with a minimally invasive surgical approach, reported in the PubMed database for the last 20 years (2001-2021) in the adult patient population (age 19 and over). The aim of this study is to highlight the asymptomatic presentation of cardiac myxomas and to underline the advantages of a minimally invasive surgical approach. In summary, asymptomatic cardiac myxomas are rare incidental findings. Attention to subtle symptoms during a physical exam and scrupulous history-taking can provide a clue to this diagnosis. Early diagnosis of cardiac myxomas is crucial to prevent life-threatening complications. Minimally invasive surgery is a promising alternative approach to standard open-heart surgery for treating cardiac myxomas, providing faster recovery and higher patient satisfaction with surgical care.
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Affiliation(s)
- Tetyana Okan
- Department of Diagnostic Imaging, The Metropolitan Andrey Sheptytsky Hospital, Lviv, UKR
| | - Oleksandr Babliak
- Department of Cardiac Surgery, Cardiac Surgery Center "Dobrobut", Kyiv, UKR
| | - Kriti Agarwal
- Department of Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Yulia Kuzyk
- Department of Pathological Anatomy and Forensic Medicine, Danylo Halytsky Lviv National Medical University, Lviv, UKR
| | | | - Beshoy Iskander
- Department of Internal Medicine, Bon Secours Mercy Health- St. Elizabeth Youngstown Hospital (NEOMED), Youngstown, USA
| | - Sanjeev Sharma
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, USA
| | - Satish Tadepalli
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Richa Jaiswal
- Department of Pathology, Medical University of South Carolina, Charleston, USA
| | - Akbar Hussain
- Department of Internal Medicine, Keystone Health System, Chambersburg, USA
| | - Mohammed Y Rashid
- Department of General Surgery, University of Illinois -MGH, Chicago, USA
| | - Raja Chandra Chakinala
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA.,Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
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