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Balachandran V, Young V, Baillie T, James A. Primary left ventricular leiomyosarcoma: a case report. J Cardiothorac Surg 2024; 19:168. [PMID: 38566159 PMCID: PMC10985868 DOI: 10.1186/s13019-024-02680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024] Open
Abstract
Cardiac leiomyosarcomas are a rare subset of the already infrequent, primary malignant cardiac neoplasia spectrum. The most common site for a primary leiomyosarcoma of the ventricle is on the right with fewer than five globally reported cases in the left ventricle. Most present with non-specific symptoms but attention is usually sought after the appearance of compressive symptoms or arrhythmias. We present a case of a left ventricular leiomyosarcoma in a 50-year old female patient that had a delayed diagnosis and its subsequent surgical resection and oncological management with docetaxel and gemcitabine. This case highlights the need for a high index of suspicion for cardiac masses especially if there are competing chronic diseases with similar symptomatology. Given the rare presentation of left ventricular leiomyosarcomas, case reports may provide valuable information that is otherwise unavailable.
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Affiliation(s)
- Vipin Balachandran
- Conjoint Associate Lecturer, School of Medicine and Public Health, University of Newcastle; Adjunct Teaching Fellow, University of Western Australia, Perth, Australia.
- Department of Cardiothoracic Surgery, John Hunter Hospital, Ward F3, Lookout Road, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | | | - Tina Baillie
- Douglass Hanly Moir Pathology, Newcastle, Australia
| | - Allen James
- Department of Cardiothoracic Surgery, John Hunter Hospital, Ward F3, Lookout Road, New Lambton Heights, Newcastle, NSW, 2305, Australia
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Osawa A, Utsunomiya H, Takanashi S, Takahashi S, Nakano Y. Successful surgical resection of a metastatic clear cell sarcoma in the heart: a case report. Eur Heart J Case Rep 2024; 8:ytae174. [PMID: 38651083 PMCID: PMC11033952 DOI: 10.1093/ehjcr/ytae174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
Background Clear cell sarcoma (CCS) is a very rare disease and one with a very poor prognosis. Furthermore, its occurrence in the heart is very rare and past reports are scarce. Case summary A 33-year-old man who had undergone left arm amputation due to CCS came to the hospital because a positron emission tomography computed tomography (PET-CT) four years post-amputation showed an accumulation in the heart. The PET-CT with glucose suppression treatment showed fluorodeoxyglucose accumulation in the myocardium between the middle of the anterolateral wall and the papillary muscle of the posterior lateral wall of the left ventricle (LV). Based on the course of the disease up to now, it was considered that the accumulation was most likely metastasis of CCS. Observation of the heart after a median sternotomy revealed a white tone, well-defined lesion in the middle of the anterolateral wall of LV. The tumour on the posterolateral side of LV was not exposed on the surface, but it was palpated and was still recognizable as a firm neoplastic lesion. Because the mass was identified as a sarcoma on intraoperative rapid pathology, we decide to perform a total resection. Both lesions were excised, and pathology revealed a diagnosis of CCS. Discussion Clear cell sarcoma is a very rare disease that accounts for <1% of all soft tissue sarcomas, and its occurrence in the heart is even rarer. It requires a combination of many imaging modalities. To our knowledge, this is the first case of CCS in the heart treated with surgical resection.
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Affiliation(s)
- Ayano Osawa
- Department of Cardiovascular Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Shinya Takahashi
- Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Bernal Torres W, Vinasco LAG, Gómez JE, de León JDLP. Cardiac paraganglioma: implications and impacts of a rare disease-a case report †. Eur Heart J Case Rep 2024; 8:ytae032. [PMID: 38496798 PMCID: PMC10941256 DOI: 10.1093/ehjcr/ytae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 03/19/2024]
Abstract
Background Tumour-producing catecholamines arise in the adrenal medulla (pheochromocytomas), as well as in extra-adrenal chromaffin cells (paragangliomas). The origin can be from any location; however, it is very rare in the heart. Case summary A 43-year-old woman with a history of arterial hypertension presented with dyspnoea on moderate exertion, New York Class Association (NYHA) functional classes III and IV, and oedema in the lower extremities. Medical and laboratory evaluation revealed an NT-proBNP of 6046 pg/mL, a left ventricular ejection fraction (LVEF) of 15%, longitudinal strain of -7%, and a mass located on the inner surface of the left atrioventricular groove. Surgical intervention was performed, and the tumour was resected. Pathological report showed an extra-adrenal paraganglioma without neoplastic involvement in the margins of the vena cava. After surgery, the patient showed clinical improvement with NYHA functional class I, LVEF of 56%, and longitudinal strain of -20% on transthoracic echocardiography 4 months after treatment. Discussion Paragangliomas are tumours that are rarely found in the heart, and their diagnosis is difficult. However, early detection and treatment can improve the quality of life of affected patients.
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Affiliation(s)
- Wikler Bernal Torres
- Departamento de Cardiología, Fundación Valle del Lili, Cra. 98 # 18-49, 760026 Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad ICESI, Cl. 18 # 122-135, 760031 Cali, Colombia
| | - Leidy A Giraldo Vinasco
- Facultad de Ciencias de la Salud, Universidad ICESI, Cl. 18 # 122-135, 760031 Cali, Colombia
- Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
| | - Juan Esteban Gómez
- Departamento de Cardiología, Fundación Valle del Lili, Cra. 98 # 18-49, 760026 Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad ICESI, Cl. 18 # 122-135, 760031 Cali, Colombia
| | - Juan D López Ponce de León
- Departamento de Cardiología, Fundación Valle del Lili, Cra. 98 # 18-49, 760026 Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad ICESI, Cl. 18 # 122-135, 760031 Cali, Colombia
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Cistulli D, Othman F, Karim R, Puranik R. Hibernoma: a case report of a rare cardiac tumour. Eur Heart J Case Rep 2024; 8:ytad612. [PMID: 38229930 PMCID: PMC10790811 DOI: 10.1093/ehjcr/ytad612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024]
Abstract
Background A cardiac hibernoma is a rare phenomenon, with just a handful of reports in the literature. They are difficult to characterize with conventional imaging including echocardiography, computed tomography (CT), cardiac magnetic resonance (CMR), or positron emission tomography (PET). Their definitive diagnosis relies primarily on histopathology via either endovascular or surgical biopsy. Previous case reports have entailed surgical excision followed by histopathology; however, surgery may be unfavourable in some patients with increased perioperative risk. Case summary We present the case of a 57-year-old woman who was referred to our cardiology service with an interatrial lipomatous mass found incidentally on chest CT for assessment of rib fractures. She had 6 months of unexplained syncope, which was attributed to superior vena cava (SVC) compression demonstrated by chest CT. The mass had benign characteristics on echocardiography, CT, and CMR but was glucose-avid on PET, which indicated a possible malignancy such as liposarcoma. Her comorbid and very significant airways disease precluded her from surgical excision, so instead, endovascular biopsy was performed. Histopathology showed brown fat which was negative for mouse double minute 2 amplification on fluorescence in situ hybridisation testing; hence, a diagnosis was made of hibernoma, a rare benign tumour of brown fat. Given the benign diagnosis and her surgical risk with severe chronic obstructive pulmonary disease, a multidisciplinary recommendation was made favouring conservative management, with careful ongoing follow-up and the consideration of SVC stenting if symptoms progressed. Discussion The definitive diagnosis of a cardiac hibernoma is complex and relies heavily on histopathology due to the contradictory findings on chest imaging. Careful consideration of management within a multidisciplinary team setting is essential to achieve a successful outcome.
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Affiliation(s)
- David Cistulli
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, Australia
| | - Farrah Othman
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, Australia
| | - Rooshdiya Karim
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, Australia
- New South Wales Health Pathology, Australia
- University of Sydney, Camperdown, NSW, Australia
| | - Rajesh Puranik
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, Australia
- University of Sydney, Camperdown, NSW, Australia
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De Roo E, Van Ryckeghem F, Kympers C, Vanderheyden M, Heyse A. Metastatic tumour of the heart as an unusual cause of ST elevation. Hellenic J Cardiol 2024; 75:103-104. [PMID: 37597769 DOI: 10.1016/j.hjc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Affiliation(s)
- Evelien De Roo
- Department of Internal Medicine, AZ Glorieux, Ronse, Belgium
| | | | - Celine Kympers
- Department of Geriatric Medicine, AZ Glorieux, Ronse, Belgium
| | | | - Alex Heyse
- Department of Cardiology, AZ Glorieux, Ronse, Belgium.
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Killian M, Barry T, Larsen C, Alsidawi S. Case series: cardiac sarcoma. Eur Heart J Case Rep 2023; 7:ytad546. [PMID: 38046649 PMCID: PMC10691649 DOI: 10.1093/ehjcr/ytad546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/22/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
Background Cardiac masses encompass a wide differential including primary and secondary malignancies and can present with a variety of symptoms, many of which are non-specific. Early identification and classification are important, particularly for cardiac malignancies such as sarcomas as these are aggressive tumours with exceptionally poor prognoses when metastases are present at diagnosis. Case summary We report two cases of patients who presented with dyspnoea and were diagnosed with cardiac sarcomas; the former a primary sarcoma (undifferentiated pleomorphic subtype) and the latter a secondary sarcoma (round cell myxoid liposarcoma) that serve as comparisons for presentation and management of different types of this disease. Computed Tomography (CT) and echocardiography imaging findings are demonstrated showing the typical location and morphology of each subtype. Discussion Cardiac sarcomas are the most common primary cardiac malignancy, of which undifferentiated pleomorphic sarcoma is a common subtype. Undifferentiated pleomorphic sarcomas are aggressive, have a tendency to arise in the left atrium, and can appear similar to benign cardiac masses. Round cell myxoid liposarcomas by contrast are rare causes of secondary cardiac malignancies, metastasizing to the heart from soft tissues. Both diagnoses carry poor prognoses and although rare, are important to recognize as timely intervention with surgery, radiotherapy, and consideration of chemotherapy is key to maximizing survival.
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Affiliation(s)
- Michael Killian
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Timothy Barry
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Carolyn Larsen
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - Said Alsidawi
- Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
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Zhanatkyzy A, Gorbunov D, Ivanova-Razumova T, Baigalkanova A, Manabay A. Giant cardiac cavernous haemangioma of the right atrium in a newborn successfully managed using combined therapy. Cardiol Young 2023; 33:2415-2417. [PMID: 37350341 DOI: 10.1017/s1047951123001476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Cardiac tumours are extremely rare. Most of the cases are diagnosed post-mortem.In this case, a tumour was found in a neonate during routine ultrasound screening in the first trimester of pregnancy. After birth, resection of the formation was performed and histologically confirmed as a cavernous haemangioma. Additionally, propranolol was prescribed in order to prevent relapse.
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Affiliation(s)
- Aikerim Zhanatkyzy
- Department of Pediatric Cardiology, National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Dmitry Gorbunov
- Department of Pediatric Cardiac Surgery, National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Tatiana Ivanova-Razumova
- Department of Pediatric Cardiology, National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Almira Baigalkanova
- Department of Pediatric Cardiology, National Research Cardiac Surgery Center, Astana, Kazakhstan
| | - Aizhan Manabay
- Department of Pediatric Cardiology, National Research Cardiac Surgery Center, Astana, Kazakhstan
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Ishibashi Y, Zhang S, Tamura S, Ishii H. Brugada phenocopy with altered ST-segment elevation in pericardial diffuse large B-cell lymphoma and effusive-constrictive pericarditis: a case report. Eur Heart J Case Rep 2023; 7:ytad463. [PMID: 37854103 PMCID: PMC10580269 DOI: 10.1093/ehjcr/ytad463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/26/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Abstract
Background Cardiac lymphoma is a rare disease. Effusive-constrictive pericarditis can be a characteristic of pericardial involvement in patients with this disease. Conversely, a phenotype with electrocardiogram changes similar to those of Brugada syndrome is called Brugada phenocopy, and these changes improve after treatment. Case summary A 71-year-old man was transported to our hospital with chest pain, hypotension, and ST-segment elevation in V1 and V2 leads during maintenance dialysis for renal failure. After arrival at the hospital, his ST-segment elevation disappeared, and emergency coronary angiography scan revealed no significant coronary artery stenoses or obstructions. His computed tomography and echocardiography scans revealed pericardial effusion and an intrapericardial mass. Further, his blood pressure dropped and ST-segment elevation recurred during dialysis after 7 days. Thus, pericardiocentesis was performed, but haemodynamic improvement was insufficient, and right catheterization findings suggested effusive-constrictive pericarditis. Meanwhile, flow cytometry of the pericardial fluid suggested the diagnosis of B-cell lymphoma; however, radical chemoradiotherapy was impossible because of cardiogenic shock. The patient died on Day 17. Further, autopsy revealed diffuse large B-cell lymphoma with pericardial and myocardial infiltration. Discussion Cardiac lymphoma is rare but can be associated with effusive-constrictive pericarditis, which may be difficult to manage even with pericardial drainage. In such cases, radical treatment, including chemotherapy, should be promptly considered, if possible. Our patient presented with Brugada-type electrocardiogram but no syncope or family history, suggesting Brugada phenocopy and not true Brugada syndrome due to cardiac lymphoma. Notably, temporary improvement in ST-segment elevation was observed despite the absence of treatment.
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Affiliation(s)
- Yohei Ishibashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
- Department of Cardiology, National Hospital Organization Takasaki General Medical Center, 36, Takamatsu Takasaki, Gunma 370-0829, Japan
| | - Shanshan Zhang
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa Maebashi, Gunma 371-8511, Japan
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Futami S, Hieda M, Fukata M, Shiose A. A rare case of cardiac myxoma with light bulb-like cystic morphology: a case report. Eur Heart J Case Rep 2023; 7:ytad331. [PMID: 37547377 PMCID: PMC10398420 DOI: 10.1093/ehjcr/ytad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/31/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
Background Cystic myxomas are quite rare. Moreover, few reports have evaluated the causes that constituted them. Case summary A 73-year-old Asian man presented for pre-operative examination of osteoarthritis, and transthoracic echocardiography (TTE) revealed an incidental intracardiac mass. Therefore, he was referred to our department for further evaluation. He had no specific symptoms or family history related to tumours and heart failure. The TTE showed a 32 × 24 mm spherical mass adherent to the left atrial septum. The upper part of the mass was cystic in formation and hypoechoic inside and resembled a light bulb. Transoesophageal echocardiography showed the feeding arteries flowing from the bottom into the cystic part. In addition, two jet strips drained from the cystic part in the direction of the mitral valve. Coronary angiography revealed the feeding arteries, which consisted mainly of the right coronary artery conus branch and the left circumflex branch, and the blood flowed into the saccular area from the feeding arteries and excreted towards the mitral valve. Surgical resection was performed due to the mobility, and the histopathology confirmed a cystic myxoma. Discussion We described the unique anatomical formation of a cystic myxoma, which consisted of an exquisite balance between the tumour-feeding arteries and the draining outlet vessels.
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Affiliation(s)
- Shutaro Futami
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Clinical Research Building B6F, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan
| | | | - Mitsuhiro Fukata
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Clinical Research Building B6F, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan
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Yafasova A, Møller JE, Smerup MH, Dahl JS, Fosbøl EL. Case report of rare highly aggressive cardiac tumour: the intimal sarcoma. Eur Heart J Case Rep 2023; 7:ytad004. [PMID: 36694874 PMCID: PMC9856333 DOI: 10.1093/ehjcr/ytad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/11/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Background Primary cardiac tumours are rare, and diagnosis may be difficult, as symptoms and cardiac imaging may mimic other cardiac diseases. The intimal sarcoma is the least commonly reported cardiac tumour with only few cases reported worldwide. In this case report, we present a case of an intimal sarcoma with a highly aggressive disease course. Case summary A 60-year-old male with a history of prior aortoplasty due to congenital aortic stenosis, mechanical aortic valve replacement, and aortic stenting due to aortic dilatation presented with night sweats, malaise, and dyspnoea. Initial imaging (including transthoracic and transoesophageal echocardiography and emergency computed tomography) revealed masses suspected to be thrombi in the left atrium and ventricle. However, a positron emission tomography/computed tomography scan revealed that the masses were suspicious for malignancy. The patient underwent non-radical tumour resection and insertion of biological valve prostheses. Subsequent tissue analysis and pathology assessment revealed an intimal sarcoma. There were no curative treatment options, and the patient succumbed to his illness <3 months after surgery. Discussion This case report presents a case of a highly aggressive intimal sarcoma. As complete tumour resection is of great importance when it comes to life expectancy in cardiac sarcomas, early diagnosis using non-invasive and invasive imaging modalities is essential to start early treatment and to improve outcomes in this patient group.
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Affiliation(s)
| | - Jacob E Møller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Morten H Smerup
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Kikuchi DS, Goulbourne CA, Starbuck KD, Fernandes MF. Case report: intravenous leiomyomatosis with intracaval and intracardiac growth. Eur Heart J Case Rep 2022; 7:ytac464. [PMID: 36600803 PMCID: PMC9799196 DOI: 10.1093/ehjcr/ytac464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 08/02/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
Background Intravenous leiomyomatosis (IVL) is a rare, benign smooth muscle cell tumour that extends beyond the pelvis. These tumours grow within vascular channels and can progress to involve the heart and pulmonary vasculature. Case Summary A 44-year-old female initially presented to her primary care physician for subacute bloating. In the weeks leading up to her presentation, she was in good health. On admission, computed tomography (CT) imaging of the abdomen and pelvis was notable for a mixed solid and cystic mass arising from the fundal myometrium with invasion into the inferior vena cava (IVC). Transthoracic echocardiogram (TTE) was notable for mobile mass in the right atrium originating from the IVC. The mass was further evaluated by cardiac magnetic resonance (CMR) imaging before a multidisciplinary, single-staged thoracoabdominal resection was performed. The procedure was well tolerated, and the entire mass was successfully removed without complication. Subsequently, pathological analysis of the resected tumour revealed benign smooth muscle cells, confirming the diagnosis of IVL. Discussion Intravenous leiomyomatosis is a rare cause of right-sided cardiac tumours but should be considered in premenopausal females, even those with a prior history of hysterectomy. The clinical presentation of patients with IVL is varied and imaging including CMR, CT, and TTE to evaluate the tissue characteristics and source of the cardiac mass should be performed. Finally, while imaging revealing a freely mobile pelvic mass extending into the IVC and right heart chambers is strongly suggestive of IVL, definitive diagnosis requires pathological analysis of resected tissue.
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Affiliation(s)
| | - Clive A Goulbourne
- Division of Cardiology, Department of Medicine, Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322, USA
| | - Kristen D Starbuck
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, Emory University, 1364 E Clifton Rd NE, Atlanta, GA 30322, USA
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Wang F, Li L, Ma H, Chi XX. A primary cardiac schwannoma of the right ventricle: a case report and literature review. BMC Cardiovasc Disord 2022; 22:498. [PMID: 36418938 PMCID: PMC9682788 DOI: 10.1186/s12872-022-02941-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary cardiac schwannoma remains extremely rare and difficult to distinguish from other myocardial tumours. We report a case of cardiac schwannoma that occurred in the lateral wall of the right ventricle and grew in the myocardial walls. It is the third case of schwannoma that occurred in the free wall of the right ventricle. Moreover, we reviewed and summarised the literature for cases involving benign cardiac schwannomas. CASE PRESENTATION We present a case of a 64-year-old woman who presented to our centre with syncope for 1-2 min. Echocardiogram and contrast-enhanced computed tomography subsequently revealed a 2.9 × 1.9 cm homogeneous mass originating from the anterior wall of the right ventricle. The patient underwent thoracotomy to resect the mass, which was pathologically verified as Schwann cell tumour. CONCLUSIONS This is a rare case added to the limited existing literature on cardiac schwannoma. Comprehensive analysis of various imaging examinations is helpful to determine the extent of the tumour. Complete surgical resection is recommended for similar cases involving cardiac schwannomas, especially when the patient has related symptoms. Patients generally have a good prognosis. The pathogenesis of cardiac schwannoma needs further research in order to prevent and manage this rare lesion.
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Affiliation(s)
- Fang Wang
- grid.440323.20000 0004 1757 3171Department of Radiology, Shangdong Province, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20, Yuhuangding East Road, Zhifu District, Yantai, 264000 People’s Republic of China
| | - Lin Li
- Department of Pathology, Yucheng People’s Hospital, Yucheng, Dezhou, China
| | - Heng Ma
- grid.440323.20000 0004 1757 3171Department of Radiology, Shangdong Province, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20, Yuhuangding East Road, Zhifu District, Yantai, 264000 People’s Republic of China
| | - Xiao-Xiao Chi
- grid.440323.20000 0004 1757 3171Department of Radiology, Shangdong Province, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20, Yuhuangding East Road, Zhifu District, Yantai, 264000 People’s Republic of China
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 588] [Impact Index Per Article: 294.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Faim D, Francisco A, Pires A. Cardiac tumours in children: a single-centre experience and literature review. Cardiol Young 2022; 32:1-10. [PMID: 35225200 DOI: 10.1017/s1047951122000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac tumours are extremely rare in children. Although more than 90% are benign, children can develop obstructive or embolisation derived symptoms, arrhythmias, constitutional symptoms, cardiac tamponade, or even sudden death. Although the majority are asymptomatic, and some spontaneously regress, appropriate follow-up is needed on a case-by-case basis, as patients may develop late symptoms. Definitive diagnosis is only possible through histological analysis; however, it is possible to infer tumour type with a high grade of certainty based on imaging features, particularly cardiac magnetic resonance. Surgical resection is advocated for those causing symptoms, obstruction, cardiac dysfunction, and high risk of embolisation. The aim of this review is to present the state of the art related to cardiac tumours in the paediatric population, in the context of our own experience.
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Affiliation(s)
- Diogo Faim
- Department of Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Andreia Francisco
- Department of Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Pires
- Department of Paediatric Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Straw S, Sengupta A, Gantenby VK, Schlosshan D, Ferrara A, Witte KK. An enormous right atrial myxoma highlights the role of echocardiography in heart failure pathways: a case report. Eur Heart J Case Rep 2022; 6:ytac042. [PMID: 35233493 PMCID: PMC8874817 DOI: 10.1093/ehjcr/ytac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/27/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Myxomata are rare, benign, primary tumours of the heart which can present with a variety of symptoms depending on size, location, and mobility. Here, we report a case of enormous right atrial myxoma, obliterating the right atrial and right ventricular cavities presenting with symptoms of heart failure. CASE SUMMARY A 66-year-old Caucasian female presented to primary care with symptoms of right heart failure and was found to have elevated N-terminal pro B-type natriuretic peptide of 2829 ng/L (normal value <125 ng/L). The patient was referred for urgent evaluation to the integrated heart failure service at our institution. Echocardiography revealed an enormous mobile mass attached to the right atrial septum, extending into the right ventricle and inferior vena cava measuring 90 × 42 mm. The patient underwent urgent surgical resection. Perioperative transoesophageal echocardiography demonstrated severe tricuspid regurgitation, which was treated with tricuspid annuloplasty ring. The patient made an uneventful recovery and was discharged. Subsequent imaging showed a reduction in right ventricular dimensions and improved systolic function. DISCUSSION This case serves to remind us of the critical role of echocardiography in the diagnosis and management of people with breathlessness and raised natriuretic peptides. Therapies for heart failure are guided by ejection fraction, therefore timely and accurate diagnosis is critical. Moreover, as in this case, echocardiography can also identify other features of critical relevance to patient care.
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Affiliation(s)
- Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anshuman Sengupta
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - V Kate Gantenby
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Antonella Ferrara
- Department of Cardiothoracic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Internal Medicine, RWTH Aachen University, Aachen, Germany
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Ho K, Yatham K, Seno R, Sultan O. A case report of primary cardiac intimal sarcoma presenting with atrial fibrillation and a left atrial mass. Eur Heart J Case Rep 2021; 5:ytab410. [PMID: 34859182 PMCID: PMC8633751 DOI: 10.1093/ehjcr/ytab410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/09/2021] [Accepted: 10/05/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Intimal sarcoma is an exceedingly rare type of primary cardiac tumour. It is characterized by poorly differentiated spindle-shaped cells that can mimic smooth muscle and is strongly associated with MDM2 genetic amplification. Owing to its rarity and non-distinctive histological features, diagnosis remains a significant challenge. CASE SUMMARY In this case report, we describe a case of primary cardiac intimal sarcoma in a 37-year-old woman who presented with atrial fibrillation (AF) and a left atrial mass. Despite having a histological sample from an excised left atrial mass, the diagnosis was not made until she presented with back pain secondary to metastatic disease to the spine. DISCUSSION Primary cardiac intimal sarcoma is an extremely rare diagnosis. The mainstay management of intimal cardiac sarcoma is aggressive surgical resection. Unfortunately, the prognosis of cardiac sarcomas remains very poor, with a mean survival between 3 months and 1 year. This case of cardiac intimal sarcoma highlights the difficulty in establishing a diagnosis, particularly given the unusual presentation of AF.
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Affiliation(s)
- Karen Ho
- Department of Medicine, University of Saskatchewan College of Medicine, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
| | - Kavya Yatham
- Department of Medicine, University of Saskatchewan College of Medicine, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
| | - Rommel Seno
- Department of Medicine, University of Saskatchewan College of Medicine, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, 4101 Dewdney Avenue, Regina, SK, Canada S4T 1A5
| | - Omar Sultan
- Department of Medicine, University of Saskatchewan College of Medicine, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
- Department of Cardiology, Saskatchewan Health Authority, 1440 14th Avenue, Regina, SK, Canada S4P 0W5
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Sato W, Seki K, Yamamoto H, Watanabe H. Thrombosed sinus of Valsalva aneurysm masquer ading as a cardiac tumour: a case report. Eur Heart J Case Rep 2021; 5:ytab259. [PMID: 34423239 PMCID: PMC8374963 DOI: 10.1093/ehjcr/ytab259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/30/2020] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
Background An aortic sinus of Valsalva aneurysm (SVA) often remains undiagnosed until it ruptures. An SVA filled with thrombus can be challenging to diagnose accurately. Case summary A 70-year-old man was admitted with a clinical diagnosis of well-tolerated complete atrioventricular block (AVB). Transthoracic echocardiography revealed a spherical mass (43 × 49 mm) at the interatrial septum. Enhanced computed tomography (CT) showed a well-defined, hollow, and non-enhanced mass suggesting a cardiac tumour. However, 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) showed no uptake in the mass. After implantation of a permanent pacemaker, anticoagulant therapy was started for paroxysmal atrial fibrillation. Two months later, follow-up evaluation by echocardiography and enhanced CT revealed an increase in size of the hollow interior cavity, suggesting thrombolysis by the anticoagulant. We diagnosed a non-coronary SVA filled with thrombus, which masqueraded as a cardiac tumour and may have caused complete AVB. Conclusions We describe a rare case of a giant thrombosed SVA masquerading as a cardiac tumour. Initial 18F-FDG PET/CT and serial imaging studies were helpful in distinguishing it from a cardiac tumour.
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Affiliation(s)
- Wakana Sato
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondoh, Akita 010-8543, Japan
| | - Katsuhito Seki
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondoh, Akita 010-8543, Japan
| | - Hiroshi Yamamoto
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondoh, Akita 010-8543, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondoh, Akita 010-8543, Japan
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Artico J, Belgrano M, Bussani R, Sinagra G. The curious case of a massive right heart thrombosis: a case report. Eur Heart J Case Rep 2021; 5:ytab156. [PMID: 34377897 PMCID: PMC8343560 DOI: 10.1093/ehjcr/ytab156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/08/2020] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
Background Intraventricular masses are a relatively rare condition ranging from asymptomatic to potentially life-threatening situations. Case summary Herein, we report a case of a 49-year-old woman under investigation for a massive right ventricular (RV) mass who underwent complete investigation for possible differential diagnosis, in the suspect of RV tumour. Multimodality imaging with cardiac computed tomography and magnetic resonance imaging showed the presence of a massive thrombus partially obliterating the right ventricle. Surgical removal of the mass showed a large area of stratified thrombosis with an underlying area of endocardial fibrosis. The patient has been then discharged in good clinical condition and with lifetime oral anticoagulation. Discussion Massive RV thrombosis is a rare yet potentially fatal condition. Invasive management is preferable and lifetime anticoagulation is required to reduce possible downstream thrombotic complications.
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Affiliation(s)
- Jessica Artico
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata and University of Trieste, Via Pietro Valdoni 7, 34100 Trieste, Italy
| | - Manuel Belgrano
- Department of Radiology, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
| | - Rossana Bussani
- Department of Pathology, Azienda Sanitaria Universitaria Integrata and University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata and University of Trieste, Via Pietro Valdoni 7, 34100 Trieste, Italy
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Ho YL, Ng PF, Krishinan S, Abdul Kareem BA. Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man. J Cardiothorac Surg 2021; 16:151. [PMID: 34051789 PMCID: PMC8164241 DOI: 10.1186/s13019-021-01526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation. CASE PRESENTATION We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination. CONCLUSION Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.
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Affiliation(s)
- Yan Le Ho
- Department of Cardiothoracic Surgery, Penang General Hospital, Georgetown, Malaysia.
| | - Pui Fong Ng
- Department of Pathology, Penang General Hospital, Georgetown, Malaysia
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Kynta RL, Rawat S, Lyngdoh BS, Gunasekaran AK, Fanai V, Kapoor M, Joseph HT. Eustachian valve myxoma: a rare cause of Budd-Chiari syndrome. Gen Thorac Cardiovasc Surg 2021; 69:1243-6. [PMID: 34036487 DOI: 10.1007/s11748-021-01641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Budd-Chiari syndrome caused by right atrial myxomas are extremely rare. We report the case of a patient who presented with chronic liver disease who upon consequent investigation was found to have a mass occupying the right atrium and ventricle consistent with cardiac tumour. Intraoperatively, a giant mass was removed from the right atrium with the tumour stalk originating from the Eustachian valve. Histologic findings were consistent with myxoma.
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Yildirim S, Işik M, Tanyeli Ö, Görmüş N. Giant left atrial capillary haemangioma invading left-main coronary artery. Interact Cardiovasc Thorac Surg 2021; 33:631-633. [PMID: 34000032 DOI: 10.1093/icvts/ivab133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/20/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Cardiac haemangiomas are rare cases and can be seen at any age of life. A 49-year-old woman was admitted to our hospital with chest pain. A well-circumscribed soft tissue mass extending from the pulmonary artery truncus to the left ventricular inferior neighborhood. Following surgical resection, the patient was discharged 4 days after surgery.
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Affiliation(s)
- Serkan Yildirim
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| | - Mehmet Işik
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| | - Ömer Tanyeli
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
| | - Niyazi Görmüş
- Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Medicine Faculty, Konya, Turkey
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Avella A, Giordano C, Buffa V, De Girolamo P, Uguccioni M. Diagnosis of Primary Cardiac T-cell Lymphoma: Feasibility and Safety of Endomyocardial Biopsy Guided by Pre-acquired Cardiovascular Magnetic Resonance. Eur J Case Rep Intern Med 2021; 8:002427. [PMID: 33869103 DOI: 10.12890/2021_002427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 11/05/2022] Open
Abstract
Background Multimodality imaging of a cardiac mass lesion may raise suspicion of a primitive cardiac lymphoma (PCL). However, a definitive diagnosis requires histopathological confirmation. Methods This report describes the methodology we used to perform biopsy sampling of a cardiac mass lesion affecting a 45-year-old man. In order to increase endomyocardial biopsy diagnostic accuracy, we used pre-acquired cardiac magnetic resonance (CMR) images to guide the bioptome on a cardiac site overtly infiltrated by the suspected tumour. The right ventricular outflow tract was identified as the target site for biopsy sampling. To reduce the risk of the procedure, the biopsy was performed at a safe distance from the tip of a diagnostic quadripolar catheter positioned at the level of the pulmonary valve, previously identified by pacing manoeuvres. The reported approach demonstrated safety and diagnostic accuracy, allowing the identification of an extremely rare PCL subtype of T-cell origin. Conclusion Biopsy sampling of a suspected tumour may be safely and accurately performed using pre-acquired CMR images to guide the bioptome on the target site. LEARNING POINTS Multimodal imaging techniques capable of tissue characterization may raise suspicion of a primary cardiac lymphoma (PCL).However, the final diagnosis of PCL can be confirmed only by histological examination of a tissue sample.Biopsy sampling of the mass lesion may be accurately guided by previously acquired cardiac magnetic resonance images.
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Affiliation(s)
- Andrea Avella
- Cardiology Division and Cardiac Arrhythmia Unit, St. Camillo-Forlanini Hospital, Rome, Italy
| | - Carla Giordano
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | - Vitaliano Buffa
- Cardiovascular Imaging Unit, St. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Massimo Uguccioni
- Cardiology Division and Cardiac Arrhythmia Unit, St. Camillo-Forlanini Hospital, Rome, Italy
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Saku K, Tahara N, Fukumoto Y, Tanaka H. Isolated right ventricular metastasis of hepatocellular carcinoma induced by epithelial-mesenchymal transition: a case report. Eur Heart J Case Rep 2020; 5:ytaa517. [PMID: 33598612 PMCID: PMC7873797 DOI: 10.1093/ehjcr/ytaa517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/18/2020] [Accepted: 11/21/2020] [Indexed: 11/14/2022]
Abstract
Background Hepatocellular carcinoma (HCC) that metastasizes to the right ventricle has rarely been reported. An important link between epithelial-mesenchymal transition (EMT) and the invasion and metastasis of cancer cells has recently been demonstrated. However, there are few reports on the relationship between HCC metastasized to the heart and EMT. Case summary We here report the case of a 74-year-old woman who had type C HCC referred to our hospital with general fatigue due to a right ventricular tumour diagnosed at a general hospital. Anticoagulation therapy was done, but the mass had rapidly grown. We performed surgical resection of the mass. Histopathological examination revealed that the tumour was diagnosed as a poorly differentiated HCC metastasis induced by EMT. Discussion Isolated metastasis of HCC to the right ventricle is extremely rare. The HCC with EMT has a potentially high risk of metastasizing to the heart and other organs, and the prognosis is poor.
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Affiliation(s)
- Kosuke Saku
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
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Pedrosa C, Miotto HC, Drumond LF, Andrade MM, Zille PC, Palhares GT, Abrahao-Machado LF. Right heart failure due to benign metastasizing leiomyoma: a case report of this exceedingly rare condition and review of the literature. Eur Heart J Case Rep 2020; 4:1-7. [PMID: 33442611 PMCID: PMC7793117 DOI: 10.1093/ehjcr/ytaa468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Benign metastasizing leiomyoma (BML) is a smooth muscle tumour of genital origin occurring in women with a history of uterine or pelvic leiomyoma. Although histologically benign, it exhibits metastatic behaviour. Lungs are the most common site of metastasis. The heart is a rare site and metastasis at this location has been described in just few cases. CASE SUMMARY A 42-year-old woman with a resected uterine leiomyoma and a subsequent and still not-resected left periovarian solid mass began complaining of shortness of breath 2 weeks before presentation. Echocardiography showed a mass located in the right ventricular cavity, enlargement of the right ventricle, and severe tricuspid regurgitation. Cardiac magnetic resonance revealed two masses suggestive of tumours in the right ventricle causing right ventricular outflow tract obstruction. Cardiac surgery was performed and, intraoperatively, a third small mass was detected on the tricuspid valve. The masses were resected, and tricuspid valve replacement was performed. Ten days later, the patient underwent an abdominal surgery for the pelvic mass resection. Immunohistochemical analysis of the cardiac and pelvic masses corroborated the diagnosis of benign leiomyomas. The patient was discharged in good clinical condition. DISCUSSION Benign metastasizing leiomyoma to the heart is a rare condition. The pathogenesis remains controversial and includes: (i) vascular or lymphatic spread of myomatous tissue cells when leiomyoma resection or hysterectomy is performed and (ii) smooth muscle cell proliferation in multiple regions. The more usual locations of BML in the heart seem to be the tricuspid valve and the right face of the interventricular septum.
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Affiliation(s)
- Cesar Pedrosa
- Biocor Instituto, Alameda Oscar Niemeyer, 217, Nova LIma, MG, Brazil, 34006-056
| | | | | | | | - Paula Chaves Zille
- Biocor Instituto, Alameda Oscar Niemeyer, 217, Nova LIma, MG, Brazil, 34006-056
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Reis Soares R, Ferber Drumond L, Soares da Mata D, Miraglia Firpe L, Tavares Mendonça Garretto JV, Ferber Drumond M. Cardiac metastasizing leiomyoma: A case report. Int J Surg Case Rep 2020; 77:647-650. [PMID: 33395865 PMCID: PMC7708872 DOI: 10.1016/j.ijscr.2020.11.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cardiac intracavitary growth of metastasizing tumour is unusual. Benign Metastasizing Leiomyoma (BML) from the uterus to the heart is extremely rare. It affects premenopausal women with a history of uterine leiomyoma. PRESENTATION OF CASE We report a case of a 42-year-old woman who presented three tumours in the right side of the heart, two years after a hysterectomy due to leiomyomatosis. The cardiac tumours were resected and the diagnosis was uterine leiomyoma. DISCUSSION The patient developed cardiac failure due to three masses at the right side of the heart. Cardiac involvement in BML is usually asymptomatic and rare. The heart masses were surgically removed and a peri ovarian mass was detected and also removed. Although histologically benign, BML exhibits metastatic qualities. CONCLUSION It suggests that BML should be included as a differential diagnosis when a female patient presents an intra cardiac mass and a history of hysterectomy.
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Affiliation(s)
| | | | | | | | | | - Matheus Ferber Drumond
- Biocor Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazilian Society of Cardiac Surgery, Brazil
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Ascaso M, Barriuso C, Pereda D. Minimally invasive resection of a papillary fibroelastoma located at the left ventricular apex. Eur J Cardiothorac Surg 2020; 58:871. [PMID: 32725104 DOI: 10.1093/ejcts/ezaa191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- María Ascaso
- Cardiovascular Surgery Department, Hospital Clínic, Barcelona, Spain
| | - Clemente Barriuso
- Cardiovascular Surgery Department, Hospital Clínic, Barcelona, Spain
| | - Daniel Pereda
- Cardiovascular Surgery Department, Hospital Clínic, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares, Madrid, Spain
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Deng Y, Dong S, Song B. Surgical Strategy for Intravenous Cardiac Leiomyomatosis. Heart Lung Circ 2020; 30:240-246. [PMID: 32830033 DOI: 10.1016/j.hlc.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
Intravenous-cardiac leiomyomatosis (IVCL) is a rare, histologically benign but biologically aggressive tumour. Accurate diagnosis and appropriate treatment choices are important for prognosis. The best surgical approach remains unclear owing to limited evidence. This study aimed to assess surgical strategies for treating IVCL and to propose individualised surgical strategies. We searched PubMed, Web of Science, and the Cochrane Library to identify case reports and case series published in English over the last 10 years. Two (2) reviewers independently screened the literature according to the inclusion and exclusion criteria, and subsequently extracted data. One hundred and ten (110) cases were included. According to our analysis, IV cardiac leiomyomatosis is most common in the fifth decade, and the mean age at detection is 45.71±7.67 years. Most patients had undergone previous hysterectomy/myomectomy, or had a co-existing uterine leiomyoma when admitted. The most common clinical presentations were dyspnoea, palpitation, pelvic mass, and leg oedema. More patients benefited more from one-stage surgery. Seventy-eight per cent (78%) of cases experienced a surgical approach of thoracic and abdominal incisions. Extractions of IVCL were varied. Eighty-seven (87) patients experienced cardiopulmonary bypass and deep hypothermic circulatory arrest was performed on 64.4% of them. Total hysterectomy and bilateral oophorectomy, together with pelvic leiomyoma excision, were done in 76.0% of patients. Overall, surgical strategies for IVCL are varied; the optimal strategy required consideration of multiple factors. Complete resection is recommended for both single- and two-stage operations. Once complete resection is achieved, recurrence is rare.
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Affiliation(s)
- Yundan Deng
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China
| | - Shuai Dong
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China
| | - Bing Song
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China.
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Bussadori CM, Claretti M, Borgonovo S, Boz E, Papa M, Rossi C, Martelli F, Aimi M, Signorelli S, Marinelli R. Branch pulmonary artery stent placement in a dog with heart base neoplasia. J Vet Cardiol 2020; 30:17-22. [PMID: 32619933 DOI: 10.1016/j.jvc.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
A 7-year-old French bulldog was presented for evaluation of cardiac neoplasia. Two-dimensional transthoracic echocardiography revealed a mass on the base of the heart, compressing the right pulmonary artery. Computed tomography exam confirmed that a surgical approach to remove the mass would not be viable. Stent placement in the right pulmonary artery was performed to relieve external compression caused by the neoplasia. When surgery is not feasible, pulmonary artery stenting could be one aspect of a multidisciplinary approach to palliative management of heart base neoplasia.
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Affiliation(s)
- C M Bussadori
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - M Claretti
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy.
| | - S Borgonovo
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - E Boz
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - M Papa
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - C Rossi
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - F Martelli
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - M Aimi
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - S Signorelli
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
| | - R Marinelli
- Department of Cardiology of Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131, Milano, Italy
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Cleary A, McMahon CJ. Literature review of international mammalian target of rapamycin inhibitor use in the non-surgical management of haemodynamically significant cardiac rhabdomyomas. Cardiol Young 2020; 30:923-33. [PMID: 32524929 DOI: 10.1017/S104795112000147X] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cardiac rhabdomyomas represent the most common primary paediatric cardiac tumour and typically regresses over time in the majority of patients. Among those who are symptomatic, surgical resection or catheterisation procedures have traditionally proven effective. More recently, those invasive or challenging tumours have been successfully treated with mammalian target of rapamycin inhibitors, typically everolimus and sirolimus. This review outlines the current medical literature of the state-of-the-art medical treatment of these tumours. We specifically focus on dosing regimens, duration of therapy, and side-effect profiles of mammalian target of rapamycin inhibitors among this population. Although the majority of cases responded to mammalian target of rapamycin inhibition, standardised guidelines for dosing and duration of treatment remain to be defined.
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Cervetti MR, Camporrotondo M, Clusa NM, Navia D. Advanced calcification of a left atrial myxoma. Eur J Cardiothorac Surg 2020; 57:196. [PMID: 31168588 DOI: 10.1093/ejcts/ezz175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Manuel Roque Cervetti
- Department of Cardiac Surgery, Institute Cardiovascular of Buenos Aires, Buenos Aires, Argentina
| | - Mariano Camporrotondo
- Department of Cardiac Surgery, Institute Cardiovascular of Buenos Aires, Buenos Aires, Argentina
| | - Nestor Manuel Clusa
- Department of Cardiac Surgery, Institute Cardiovascular of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Navia
- Department of Cardiac Surgery, Institute Cardiovascular of Buenos Aires, Buenos Aires, Argentina
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Abstract
We present a case of a large left ventricular capillary haemangioma incidentally discovered in a pre-adolescent patient.
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Monzón Díaz D, Cuerpo Caballero G, Irabien Ortiz A, Gonzalez Pinto Á. Inflammatory myofibroblastic tumour in the right ventricle of a 66-year-old man. Interact Cardiovasc Thorac Surg 2019; 29:967-968. [PMID: 31384927 DOI: 10.1093/icvts/ivz189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/26/2019] [Accepted: 07/07/2019] [Indexed: 11/14/2022] Open
Abstract
Herein, we present the case of a 66-year-old man with an inflammatory myofibroblastic tumour. An inflammatory myofibroblastic tumour is an extremely rare entity, with only 60 cases having been reported to date in the literature. The origin of this type of tumour is unknown and the treatment of choice is surgical resection. We present the surgical technique of our case and a review of the literature regarding this tumour. This is the first case described in a man above 60 years of age with a tumour located in the right ventricle.
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Affiliation(s)
- Diego Monzón Díaz
- Cardiovascular Surgery Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Angela Irabien Ortiz
- Cardiovascular Surgery Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Gonzalez Pinto
- Cardiovascular Surgery Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Hiremath CS, Gandrakota S, Doddamane AN, Diwakar A. A calcified amorphous tumour in a patient with coronary artery disease: an atypical entity. Interact Cardiovasc Thorac Surg 2019; 29:805-807. [PMID: 31365072 DOI: 10.1093/icvts/ivz162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 11/12/2022] Open
Abstract
We describe a case of a 46-year-old man with calcified amorphous tumour in the right atrium and significant coronary artery disease. Preoperative investigations revealed a polypoid oscillating mass arising from the interatrial septum and attached to the tricuspid valve annulus. On-pump complete extirpation of the tumour with concomitant coronary artery bypass grafting was performed successfully. The patient's postoperative course was uneventful.
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Affiliation(s)
- Channabasavaraj S Hiremath
- Department of Cardiovascular & Thoracic Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, India
| | - Sudheer Gandrakota
- Department of Cardiovascular & Thoracic Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, India
| | - Aditya N Doddamane
- Department of Cardiovascular & Thoracic Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, India
| | - Anitha Diwakar
- Department of Anaesthesia, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, India
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Polymerou I, Ojala T, Bonou P, Martelius L, Tzifa A. Successful treatment of cardiac haemangiomas with oral propranolol: a case series of two patients. Eur Heart J Case Rep 2019; 3:5522196. [PMID: 31449646 PMCID: PMC6601147 DOI: 10.1093/ehjcr/ytz093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/08/2019] [Accepted: 06/11/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cardiac haemangiomas are extremely rare tumours with equivocal surgical outcomes. Haemangiomas appearing on other sites of the body have been successfully treated with oral propranolol. To the best of our knowledge, such treatment has not been tried to date for cardiac location of haemangiomas. CASE SUMMARY We report two cases of neonatal cardiac haemangiomas, and we describe their presentation and characteristics, as well as how these were successfully treated with oral propranolol, with complete regression of the tumours within the 1st year of life. DISCUSSION Despite the rarity of cardiac haemangiomas, their presentation and complications could be dramatic with side-effects spanning from intracardiac space occupying phenomena to Kasabach-Merritt syndrome. Propranolol therapy, having been established for long now in the treatment of skin haemangiomas, should also be considered in cases of cardiac haemangiomas, particularly in the neonatal and infantile population.
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Affiliation(s)
- Ioannis Polymerou
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, Mitera Hospital, Erithrou Stavrou, Athens, Greece
| | - Tiina Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Helsinki University Hospital, Stenbäckinkatu 9, Helsinki, Finland
| | - Pipina Bonou
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, Mitera Hospital, Erithrou Stavrou, Athens, Greece
| | - Laura Martelius
- Department of Radiology, University of Helsinki, Helsinki University Central Hospital (HUCH), Stenbackinkatu 9, Helsinki, Finland
| | - Aphrodite Tzifa
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, Mitera Hospital, Erithrou Stavrou, Athens, Greece
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Schmiady MO, Inderbitzin DT, Taramasso M, Benussi S. Multiple papillary fibroelastomas: be prepared for unexpected lesions. Eur J Cardiothorac Surg 2019; 55:1236. [PMID: 30496369 DOI: 10.1093/ejcts/ezy392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/14/2018] [Accepted: 10/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Stefano Benussi
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Singh N, Goh SSC, Nand P. A large primary cardiac glomus tumour: a surgical dilemma. Eur J Cardiothorac Surg 2019; 55:1237. [PMID: 30445525 DOI: 10.1093/ejcts/ezy393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Navneet Singh
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Siew S C Goh
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Parma Nand
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
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Abstract
Intracardiac teratomas are rare primary tumours. We report the case of an infant prenatally diagnosed with an isolated multi-cystic mass developed in the right ventricle causing neonatal refractory ventricular arrhythmia. Despite rescue extracorporeal support and partial surgical resection, he died as almost all the previous reported perinatal intracardiac teratomas whatever the prenatal tolerance and the size of the tumour. The common poor outcome of fetal intracardiac teratomas should be known when counselling parents during pregnancy.
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Abstract
A 5-year-old boy with an incidentally detected cardiac murmur was referred for evaluation. Tall R waves were noted in the electrocardiogram in leads V3 and V4. Transthoracic echocardiography suggested asymmetric septal hypertrophy with diffuse thickening of the inter-ventricular septum with normal thickness of the posterior left ventricular wall. Upon closer interrogation, a masquerading sessile cardiac mass was identified adherent to the left ventricular side of the inter-ventricular septum which appeared to contract with each cardiac cycle, mimicking hypertrophic cardiomyopathy.
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Affiliation(s)
- Avinash Mani
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Arun Gopalakrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Anoop Ayyappan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ajitkumar Valaparambil
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India; Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Grantomo J, Pratita J, Rachmat J, Saraswati M. A rare case of primary cardiac lymphoma and the role of early surgical debulking: a case report. Eur Heart J Case Rep 2018; 2:yty116. [PMID: 31020192 PMCID: PMC6425998 DOI: 10.1093/ehjcr/yty116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/04/2018] [Indexed: 12/04/2022]
Abstract
BACKGROUND Primary cardiac lymphoma (PCL) is a very rare disease and is most commonly found among immunocompromised patients. Its cardiac manifestations are non-specific, leading to delayed diagnosis and poor prognosis. However, chemotherapy could improve survival, which makes early and prompt diagnosis very crucial. This is a report of a rare case of PCL found on a 73-year-old man who benefit from early debulking surgery. CASE SUMMARY A 73-year-old man presented with worsening dyspnoea over the last 2 months. A 7.2 × 10.2 cm intramural tumour was found extending from the right atrium to the right ventricle. It was considered that the tumour could cause sudden death due to its size and extension. Therefore, surgical debulking with biopsy and valve repair was done. Cytology examination from the resected specimen demonstrated diffuse large B-cell lymphoma non-germinal centre B-cell like type. He was discharged 2 weeks after the surgery in stable condition and referred to internal medicine department for chemotherapy. However, he chose palliative home care and died 44 days after surgery. DISCUSSION In cases of PCL with concerning tumour size and symptoms due to cardiac obstruction, early surgical debulking could improve haemodynamics, prevent sudden death, and confirm immunopathological diagnosis needed in determining further chemotherapy, which is proven to improve survival.
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Affiliation(s)
- Jonathan Grantomo
- Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Salemba Raya No.6, Jakarta Pusat, DKI Jakarta, Indonesia
| | - Jenni Pratita
- Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Salemba Raya No.6, Jakarta Pusat, DKI Jakarta, Indonesia
| | - Jusuf Rachmat
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Salemba Raya No.6, Jakarta Pusat, DKI Jakarta, Indonesia
| | - Meilania Saraswati
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Salemba Raya No.6, Jakarta Pusat, DKI Jakarta, Indonesia
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Thiagaraj A, Kalamkar P, Rahman R, Farah V, Poornima I. An unprecedented case report of primary cardiac lymphoma exclusive to left ventricle: a diagnostic and therapeutic challenge. Eur Heart J Case Rep 2018; 2:yty029. [PMID: 31020112 PMCID: PMC6177073 DOI: 10.1093/ehjcr/yty029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/14/2018] [Indexed: 12/04/2022]
Abstract
Introduction Primary cardiac lymphoma accounts for <2% of all primary cardiac tumours. It is uncommon in immunocompetent patients, often fatal and diagnosed at autopsy. Tumour usually involves the right heart chambers and pericardium. With advances in imaging, early diagnosis is possible and treatment including chemotherapy and surgery affords good prognosis. Case presentation We present a 50-year-old woman with abdominal pain and fevers for 5 days. Computed tomography of the abdomen showed splenic and renal infarcts but no mass or vegetation was noted on echocardiography. Thoracic computed tomography divulged a large left ventricular filling defect. Cardiac magnetic resonance imaging delineated a 3.5 × 4.5 cm anterobasal mass with frond-like projections and endocardial invasion without extracardiac involvement suggestive of a low-vascularity tumour. Echo-guided endomyocardial biopsy and minithoracotomy with needle biopsy were inconclusive. A sarcoid-protocol cardiac positron emission tomography-fluorodeoxyglucose scan showed focally elevated uptake in the basal anteroseptum without extracardiac uptake, supporting a malignant entity. This prompted open heart mass resection. Pathology revealed diffuse large B-cell lymphoma. Discussion Our case is a unique report of cardiac lymphoma isolated to the left ventricle. Location of the tumour and lack of specific imaging characteristics made it a diagnostic challenge. It underscores the importance of including lymphoma in the differential for intracardiac masses as it is responsive to chemotherapy. Additionally, it emphasizes the complementary role of imaging modalities and multidisciplinary team approach in diagnosis. Early diagnosis and therapy is the key to establishing successful outcomes.
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Affiliation(s)
- Ashwin Thiagaraj
- Department of Cardiology, Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
| | - Prachi Kalamkar
- Department of Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
| | - Riaz Rahman
- Department of Cardiology, Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
| | - Victor Farah
- Department of Cardiology, Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
| | - Indu Poornima
- Department of Cardiology, Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, USA
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Seitz A, Ong P, Backes M, Mahrholdt H. Chronic pericardial effusion in the setting of pericardial capillary haemangioma: a case report and review of the literature. Eur Heart J Case Rep 2018; 2:yty024. [PMID: 31020103 PMCID: PMC6426034 DOI: 10.1093/ehjcr/yty024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/30/2018] [Indexed: 11/18/2022]
Abstract
Introduction Cardiac haemangiomas are rare vascular tumours of the heart accounting for less than 5% of benign primary cardiac neoplasms. They are sometimes diagnosed incidentally, since patients can be asymptomatic. The clinical presentation in symptomatic patients, however, is variable, depending on size and exact localization of the tumour. Although cardiac haemangiomas have been reported everywhere in the heart, those localized in the pericardium are extremely rare. Case presentation A 48-year-old female patient with a history of pericardial effusion and pneumonia was admitted to our hospital with progressive dyspnoea on exertion. Echocardiography demonstrated recurrence of pericardial effusion with ‘swinging heart’. Further investigation by computed tomography, cardiac magnetic resonance imaging and coronary angiography revealed a hypervascular pericardial mass with typical ‘tumour blush’ after contrast injection. The tumour could be resected in toto by open heart surgery, and histological evaluation confirmed the diagnosis of a pericardial capillary haemangioma. There were no signs of recurrence of neither the pericardial effusion nor the tumour during follow-up. Discussion We here report a very rare case of a pericardial haemangioma in the adult which was diagnosed by multi-modality workup of recurrent pericardial effusion. This case illustrates that in the setting of chronic pericardial effusion non-inflammatory and non-malignant causes should be taken into account.
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Affiliation(s)
- Andreas Seitz
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Peter Ong
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Maik Backes
- Department of Radiology, Robert Bosch Medical Center, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstr. 110, 70376 Stuttgart, Germany
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Abstract
Cardiac haemangiomas are exceedingly rare; however, they can cause significant haemodynamic impairment and disturbances in heart rhythm. Rarely, cardiac tumours may also coexist with congenital heart lesions. We present an extremely unusual case of a cardiac haemangioma in the setting of complex transposition of the great arteries that caused functional tricuspid atresia. To our knowledge, this is the first such case described in the literature.
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Affiliation(s)
- Ana Rita Godinho
- Serviço de Cardiologia, Centro Hospitalar de São João, Porto, Portugal
| | - Paula Dias
- Serviço de Cardiologia, Centro Hospitalar de São João, Porto, Portugal
| | | | - Teresa Pinho
- Serviço de Cardiologia, Centro Hospitalar de São João, Porto, Portugal
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Giusca S, Mereles D, Ochs A, Buss S, André F, Seitz S, Riffel J, Fortner P, Andrulis M, Schönland S, Katus HA, Korosoglou G. Incremental value of cardiac magnetic resonance for the evaluation of cardiac tumors in adults: experience of a high volume tertiary cardiology centre. Int J Cardiovasc Imaging 2017; 33:879-888. [PMID: 28138817 DOI: 10.1007/s10554-017-1065-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/04/2017] [Indexed: 12/21/2022]
Abstract
To assess the value of cardiac magnetic resonance imaging (CMR) in evaluating cardiac tumours in a tertiary cardiology centre. Between 2004 and 2014, 125 patients (pts.) from a total of 17000 who received a CMR examination in our institution were referred with the suspicion of cardiac tumours. A dedicated protocol was used that included standard cine SSFP acquisitions as well as tissue characterization using T1 and T2 black-blood (T1 BB and T2 BB respectively) with and without fat suppression, perfusion of the structure and late gadolinium enhancement. Patients' files were retrospectively analysed and data related to clinical status, results from other examinations (echocardiography), therapeutic approach and histology results, when performed, were collected. In 65 pts., a diagnosis of cardiac tumour was reached. 45 Pts had a biopsy. The CMR examination was concordant with the histology results in 35 (76%) pts. superior to that showed by echocardiography, 26 (58%) pts., p = 0.03. Forty-two (65%) pts. had a benign tumour and 23 (35%) a malignant process. Myxoma was the most frequent benign tumour, 27 (65%) and cardiac metastases were the most frequent form of malignancies, 21 (91%), with B cell non-Hodgkin lymphoma being the most frequent one, 4 (19%). Benign tumours were mostly located in the left atrium, 27 (64%) versus 6 (26%), p = 0.007, whereas malignant tumours had a predilection for the right atrium und left ventricle [11 (48%) vs. 3 (7%), p = 0.001 and 8 (35%) vs. 3 (7%), p = 0.03]. All benign cardiac tumours were single and did not show signs of infiltration. Conversely, malignant cardiac tumours were larger (43 ± 35 vs. 24 ± 16, p = 0.007) with a significant proportion (65%) showing myocardial infiltration. Pts with malignant cardiac tumours had a higher proportion of LGE (82 vs. 60%, p = 0.05) and exhibited more frequently an isointense signal in T1 BB images (78 vs. 61%, p = 0.04). Both groups showed similar proportion of perfusion and signal intensity in the T2 BB acquisitions (p = NS). CMR is a valuable tool in evaluating cardiac tumours, proving superior to echocardiography in establishing the type of cardiac tumour.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Derliz Mereles
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andreas Ochs
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sebastian Buss
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sebastian Seitz
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philipp Fortner
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | | | - Stefan Schönland
- Department of Haematology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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47
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Abstract
Cardiac calcified amorphous tumours of the heart are rare non-neoplastic cardiac masses that can present like a malignant mass or an intra-cardiac thrombus. We report an extremely unusual case of a 73year old man who presented to hospital with dyspnoea and subsequent investigations revealed multiple cardiac CATs.
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Affiliation(s)
- Amrit Chowdhary
- Department of Cardiology, Fairfield General Hospital, Rochdale Old Road, Bury BL97TD, United Kingdom.
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48
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Kothari J, Lakhia K, Solanki P, Panchal J, Shah P. Recurrent Left Atrial Myxoma in a Young Patient: A Rare Entity. J Clin Diagn Res 2016; 10:PD05-7. [PMID: 27656501 DOI: 10.7860/jcdr/2016/20425.8321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/28/2016] [Indexed: 11/24/2022]
Abstract
Recurrence of atrial myxoma arising from the site other than inter-atrial septum is quite rare, which is more common in familial than sporadic cases. We here in present a case of 15-year-old young female who presented with recurrence of left atrial (LA) myxoma from unusual site - posterior LA wall after 3 years without any constitutional symptoms, which is the hallmark of recurrence. Complete removal of underlying atrial septum with atrial wall for recurrence prevention is the dictum in primary operation for tumour removal.
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Affiliation(s)
- Jignesh Kothari
- Associate Professor, Department of Cardio Vascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College) , New Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Ketav Lakhia
- M.Ch Resident, Department of Cardio Vascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College) , New Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Parth Solanki
- Assistant Professor, Department of Cardio Vascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College) , New Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Jigar Panchal
- Assistant Professor, Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College) , New Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Pratik Shah
- Research Fellow, Department of Research, U. N. Mehta Institute of Cardiology and Research Center, (Affiliated to B. J. Medical College) , New Civil Hospital Campus, Asarwa, Ahmedabad, India
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Mirchandani LV, Alam A, Iyer A, Kutty JT. Rare Case of Unilateral Hypoplasia of Lung with Associated Ventricular Mass in an Adult. J Clin Diagn Res 2016; 10:OD05-7. [PMID: 27630888 DOI: 10.7860/jcdr/2016/19591.8138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/16/2016] [Indexed: 11/24/2022]
Abstract
Hypoplasia of the lung is a rare congenital condition which can be: a) primary i.e. no apparent cause is found; or b) secondary i.e. associated with other congenital anomalies that are implicated in its pathogenesis. These anomalies may involve the diaphragm, cardiovascular, central nervous, urogenital and musculoskeletal system. Patients usually present in neonatal, infancy or childhood period and very rarely in adulthood. Our patient was an adult having a unilateral hypoplastic lung associated with a ventricular mass and to our knowledge this rare combination has never been reported in the English literature; though there are reports of prenatal or newborns with hypoplastic lung and rhabdomyoma of ventricle who did not survive.
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Affiliation(s)
- Lavina Vishnu Mirchandani
- Associate Professor, Department of Pulmonary Medicine, Dr. D.Y. Patil University, College of Medicine , Nerul, Navi Mumbai, Maharashtra, India
| | - Azad Alam
- Resident, Department of Pulmonary Medicine, Dr. D.Y. Patil University, College of Medicine , Nerul, Navi Mumbai, Maharashtra, India
| | - Aparna Iyer
- Assistant Professor, Department of Pulmonary Medicine, Dr. D.Y. Patil University, College of Medicine , Nerul, Navi Mumbai, Maharashtra, India
| | - Jayalakshmi Thelapurath Kutty
- Professor and Head, Department of Pulmonary Medicine, Dr. D.Y. Patil University, College of Medicine , Nerul, Navi Mumbai, Maharashtra, India
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Schneider B, Holfeld J, Grimm M, Müller L. Intrapericardial left-sided ectopic thyroid mass supplied by the left circumflex artery. Interact Cardiovasc Thorac Surg 2016; 23:671-3. [PMID: 27255293 DOI: 10.1093/icvts/ivw097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/11/2015] [Indexed: 11/13/2022] Open
Abstract
Intrapericardial left-sided ectopic thyroid tissue is a rare entity. We report a 47-year old female patient with an intrapericardial mass mounting the left atrial wall. Two prominent vessels, both originating from the left circumflex artery (LCX), supplied the tumour. Owing to the compression of the left atrium and the left upper pulmonary vein, the patient was highly symptomatic with exertional dyspnoea and ventricular extrasystoles. Histopathological examination showed regressive thyroid adenoma with no signs of malignancy. Complete resection was feasible. The evaluation of thyroid hormone levels was not indicative for diagnosis. Postoperative hormone substitution appeared to be unnecessary.
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Affiliation(s)
| | | | - Michael Grimm
- Medical University of Cardiac Surgery, Innsbruck, Austria
| | - Ludwig Müller
- Medical University of Cardiac Surgery, Innsbruck, Austria
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