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Liu L, Fang A, Cheng S, Guo G, Zhang S, Chen X, Pan J, Sun B, Yao J. Diagnosis and survival analyses of patients with space-occupying cardiac lesions: a 10-year retrospective single-center study. Quant Imaging Med Surg 2022; 12:4081-4094. [PMID: 35919055 PMCID: PMC9338381 DOI: 10.21037/qims-21-1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/01/2022] [Indexed: 12/02/2022]
Abstract
Background Space-occupying cardiac lesions are uncommon but fatal. Echocardiography can identify diseases quickly in the clinic. This study reviews the clinical data of patients with space-occupying cardiac lesions in the past 10 years and analyzes their echocardiographic features, pathological diagnosis, and prognosis. Methods We performed a retrospective analysis of 412 patients admitted to Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing from 2011 to 2020. All patients were diagnosed with cardiac masses based on transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). We compared the diagnostic results of echocardiography and the postoperative pathological diagnosis and analyzed the characteristics of different types of space-occupying cardiac lesions. We also compared the mortality of patients with different types of space-occupying cardiac lesions through follow-up results of postoperative patients. Results The 412 patients included 189 males and 223 females. Among them, 214 patients had benign tumors (including 176 patients with myxomas), 29 had primary malignant tumors, 32 had metastatic tumors, 41 had thrombi, 92 had infectious neoplasms, and 4 patients had special types of space-occupying lesions. A total of 376 lesions were correctly characterized by TTE, with an accuracy of 91.3%. Patients with benign tumors (9/214), thrombi (4/41), infectious neoplasms (5/92), or special types of space-occupying lesions (0/4) exhibited low rates of mortality or recurrence. In contrast, patients with primary malignant tumors (16/29) or metastatic tumors (16/32) exhibited high mortality rates. Conclusions Echocardiography is a valuable tool for characterizing space-occupying cardiac lesions. It can provide important preoperative diagnostic information for cardiothoracic surgeons.
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Affiliation(s)
- Lei Liu
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Aijuan Fang
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Siyuan Cheng
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Guanjun Guo
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Suming Zhang
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaofang Chen
- Department of Cardiothoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jun Pan
- Department of Cardiothoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Bugao Sun
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jing Yao
- Department of Ultrasound Medicine, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,Medical Image Center, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Rossi L, Covella B, Libutti P, Teutonico A, Casucci F, Lomonte C. How to manage catheter-related right atrial thrombosis: Our conservative approach. J Vasc Access 2020; 22:480-484. [PMID: 32410490 DOI: 10.1177/1129729820922703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Catheter-related right atrial thrombosis is an underestimated, severe, and life-threatening complication of any type of central venous catheters. No clear-cut epidemiological data are available. Catheter-related right atrial thrombosis is often asymptomatic; however, it can lead to serious complications and death. CASE SERIES We report seven catheter-related right atrial thrombosis events occurred in five hemodialysis patients; two recurrences following primary treatment are included in the report, all of them managed with a conservative approach without catheter removal. Systemic anticoagulation (vitamin K antagonists), having a well-defined target of International Normalized Ratio of 2.5-3.0, combined with urokinase as a locking solution at the end of each hemodialysis session were the therapeutic strategy used in all patients. After the first month, the anticoagulation target was reduced to an International Normalized Ratio value of 1.5-2.0 and urokinase to a weekly administration. After sixth months, when no thrombus was identified at transthoracic echocardiographic examinations, the treatment was stopped. No bleeding complications were reported. CONCLUSION The combination therapy here described is safe, quick, and effective, achieving the goal of not removing catheters.
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Affiliation(s)
- Luigi Rossi
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Bianca Covella
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Pasquale Libutti
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Annalisa Teutonico
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Francesco Casucci
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Carlo Lomonte
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
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Anesthetic Management of a Voluminous Left Atrial Myxoma Resection in a 19 Weeks Pregnant with Atypical Clinical Presentation. Case Rep Anesthesiol 2019; 2019:4181502. [PMID: 31934456 PMCID: PMC6942744 DOI: 10.1155/2019/4181502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022] Open
Abstract
We report the case of a semi-urgent cardiac surgery, in a 19 gestation age pregnant. Despite the fact that the patient was asymptomatic, except for some palpitations, a large left auricle (LA) myxoma was fortuitously diagnosed with transthoracic echocardiography (TEE). Considering the important embolic risk, the tumor was successfully removed during cardiac surgery under cardiopulmonary bypass (CPB). Fetal bradycardia following defibrillation under stable maternal and CPB conditions was successfully managed. The postoperative period and remainder of the pregnancy was smooth and the delivery uneventful.
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Dilek M, Kaya C, Karatas A, Ozer I, Arık N, Gulel O. Catheter-related atrial thrombus: tip of the iceberg? Ren Fail 2015; 37:567-71. [PMID: 25694191 DOI: 10.3109/0886022x.2015.1007461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although guidelines recommend catheters as a last resort for establishing a vascular access in patients undergoing dialysis, they continue to be used widely for this purpose. Catheter-related atrial thrombus (CRAT) is rarely reported in this group of patients, and it can lead to serious complications. The aim of this study was to determine the incidence of CRAT in patients undergoing hemodialysis with permanent-tunneled catheters. A total of 50 patients undergoing hemodialysis with permanent catheters were included in this study. The diagnosis of CRAT was based on transthoracic echocardiography findings. Thrombus was present in nine patients (18%) and related to the tip of the catheter in all cases. Except for one patient with two foci of thrombus, all patients had a single focus. There were no significant associations between the development of thrombus and the duration of catheter use or the location of the catheter. Furthermore, catheter-related atrial thrombus did not appear to have a significant effect on mortality. The asymptomatic character of CRAT can be responsible for the low reporting rates, and its exact role in increased mortality and morbidity related with catheter use remains unknown. While planning management strategies, information on different options for vascular access routes and possible catheter-related complications should be provided to all patients who will undergo dialysis, together with a discussion involving other replacement alternatives for end-stage renal disease.
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Affiliation(s)
- Melda Dilek
- Department of Nephrology, Ondokuz Mayıs University School of Medicine , Samsun , Turkey
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Fagenholz PJ, Gutman JA, Murray AF, Noble VE, Wu A, Zeimer G, Harris NS. Arterial Thrombosis at High Altitude Resulting in Loss of Limb. High Alt Med Biol 2007; 8:340-7. [DOI: 10.1089/ham.2007.1028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter J. Fagenholz
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan A. Gutman
- Hematology–Oncology Division, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alice F. Murray
- Emergency Department, New Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Vicki E. Noble
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anette Wu
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gerhard Zeimer
- Department of Thoracic, Cardiac and Vascular Surgey, Tuebingen University Hospital, Tuebingen, Germany
| | - N. Stuart Harris
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Ceresoli GL, Ferreri AJ, Bucci E, Ripa C, Ponzoni M, Villa E. Primary cardiac lymphoma in immunocompetent patients: diagnostic and therapeutic management. Cancer 1997; 80:1497-506. [PMID: 9338475 DOI: 10.1002/(sici)1097-0142(19971015)80:8<1497::aid-cncr18>3.0.co;2-0] [Citation(s) in RCA: 221] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary cardiac lymphoma (PCL) is extremely rare in immunocompetent patients. Different definition criteria have been employed in published series. Prognosis is poor due to diagnostic delay and relevance of the site of disease. METHODS Two cases observed at the study institution are reported, with a review of 48 cases published in the literature from 1980 to 1996. Only patients with lymphoma confined to the heart and/or pericardium and those with a single and asymptomatic extracardiac site were considered for analysis. RESULTS Eight patients had minimal extracardiac disease. The most common presentation was unresponsive heart failure. Electrocardiography findings were not specific. PCL usually arose in the right chambers as a mass, with or without pericardial effusion (> 80%). Chest X-rays, transthoracic echocardiography, and computed tomography scans are standard in diagnostic workup, but transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI) showed a sensitivity > 90%. Cytology of pericardial effusion was diagnostic in 67% of cases. Thoracotomy was diagnostic in all cases, whereas less invasive procedures had high false-negative rates. Gross resection has no role. Early anthracycline-containing chemotherapy appears to improve survival, whereas the role of radiotherapy has not yet been defined. CONCLUSIONS The diagnosis of PCL should be considered in patients with a cardiac mass and/or unexplained refractory pericardial effusion. Adequate diagnostic workup, including TEE and MRI, allows confirmation of the early suspicion of PCL. In the absence of a diagnostic cytology, an open biopsy may be indicated to avoid treatment delay. There is no evidence that PCL should be treated differently from other bulky aggressive lymphomas arising at other anatomic sites.
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Affiliation(s)
- G L Ceresoli
- Department of Radiochemotherapy, Ospedale San Raffaele, Milan, Italy
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Leibowitz G, Keller NM, Daniel WG, Freedberg RS, Tunick PA, Stottmeister C, Kronzon I. Transesophageal versus transthoracic echocardiography in the evaluation of right atrial tumors. Am Heart J 1995; 130:1224-7. [PMID: 7484773 DOI: 10.1016/0002-8703(95)90146-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to define the contribution of transesophageal echocardiography to the diagnosis of right atrial tumors in a large series of patients with this rare finding. Transesophageal echocardiography (TEE) has been found to be valuable in evaluating patients with intracardiac masses and has been shown to be superior to transthoracic echocardiography (TTE) in evaluating left heart masses. Between 1989 and 1993, 23 patients with either known tumors elsewhere or right atrial masses that were detected on TTE were evaluated with TEE. TEE studies were performed in the noninvasive cardiology laboratory. All patients were studied with 5 MHz biplane or omniplane transducers. The right atrium was evaluated for the presence, characteristics, extent, and attachment of any masses and for extension of these masses into the great vessels or other cardiac chambers. No complications occurred. Six patients had primary right atrial tumors. In 10 patients the tumors reached the right atrium via the inferior vena cava. Seven patients had malignant secondary tumors. TEE demonstrated three tumors not detected by TTE. Furthermore TEE provided 16 additional findings not seen on TTE. In conclusion, TEE is superior to TTE in the evaluation of right atrial tumors. TEE should be considered in patients with right atrial tumors even when these tumors have been demonstrated with TTE.
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Affiliation(s)
- G Leibowitz
- Charles and Rose Wohlstetter Noninvasive Cardiology Laboratory, Department of Medicine, New York University Medical Center, NY, USA
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Day SM, Rosenzweig BP, Kronzon I. Transesophageal echocardiographic diagnosis of right atrial thrombi associated with the antiphospholipid syndrome. J Am Soc Echocardiogr 1995; 8:937-40. [PMID: 8611297 DOI: 10.1016/s0894-7317(05)80021-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Thromboembolic disorders are a hallmark of the antiphospholipid antibody syndrome. We describe a patient with IgM antiphospholipid antibodies associated with pulmonary emboli and in situ thrombosis within an otherwise normal right atrium. Echocardiography, particularly the transesophageal study, proved invaluable in providing a diagnosis and guiding our patient's evaluation and treatment.
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Affiliation(s)
- S M Day
- Department of Medicine, New York University School of Medicine, NY, USA
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Tesoro-Tess JD, Biasi S, Balzarini L, Ceglia E, Matarazzo C, Piotti P, Musumeci R. Heart involvement in lymphomas. The value of magnetic resonance imaging and two-dimensional echocardiography at disease presentation. Cancer 1993; 72:2484-90. [PMID: 8402465 DOI: 10.1002/1097-0142(19931015)72:8<2484::aid-cncr2820720828>3.0.co;2-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND METHODS Thirty-six patients with mediastinal lymphoma were studied with chest magnetic resonance imaging (MRI) and two-dimensional echocardiography at presentation to define the extent of the disease in the paracardiac area. RESULTS Involvement of cardiac structures was present in 23 of 36 patients (64%). Pericardial contiguity was detected in 23 of 23 patients (100%) by MRI and in 18 of 23 patients (78%) by echocardiography. Pericardial effusion, present in 17 patients (74%), and pericardial infiltration, present in 7 patients (30%), were detected by both techniques in 71% and 86%, respectively. Myocardial infiltration was identified in two of two patients (100%) by MRI and in one of two patients (50%) by two-dimensional echocardiography. Extrapericardial disease was identified in 100% of patients by MRI but only in 30% of patients by echocardiography. CONCLUSIONS Extracardiac and intracardiac involvement is a frequent event in mediastinal lymphomas and should be carefully evaluated with different imaging modalities, mainly MRI, for correct diagnosis and proper management.
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Affiliation(s)
- J D Tesoro-Tess
- Diagnostic Radiology E Division, Istituto Nazionale Tumori, Milan, Italy
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Brown J, Sadler DB. Left atrial thrombi in non-rheumatic atrial fibrillation: assessment of prevalence by transesophageal echocardiography. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1993; 9:65-72. [PMID: 8492002 DOI: 10.1007/bf01142934] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To determine the prevalence of left atrial thrombus in hospitalized patients with non-rheumatic atrial fibrillation, 48 patients were consecutively studied with single-plane transesophageal echocardiography. There were 23 males (48%) and 25 females (52%). The mean age was 66 +/- 11 years (range 43-87). Thrombus was detected in 13 patients (27%): 11 were confined to the left atrial appendage, 1 to the atrial body and appendage, and 1 to the left upper pulmonary vein. Prevalence of atrial thrombus was not different among those patients with or without previous stroke [4/16 (25%) vs 9/32 (28%), p = NS] or between patients > 65 years and patients < or = 65 years old (p = NS). Atrial thrombus was detected more frequently in patients with reduced left ventricular global systolic function than in those with normal function [7/14 (50%) vs 6/34 (17%), p < 0.05]. In patients with spontaneous contrast echoes in the left atrium, thrombi were visualized more often than in those without spontaneous echoes [10/24 (41%) vs 3/24 (12%), p < 0.05]. The finding of the atrial spontaneous contrast echoes was more frequent among patients with reduced left ventricular global systolic function [11/14 (78%) vs 13/34 (37%), p < 0.02]. We conclude that in hospitalized patients with non-rheumatic atrial fibrillation the prevalence of left atrial thrombus is high. Reduced left ventricular global systolic function identifies a subset of patients at high risk for formation of thrombus in the left atrium.
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Affiliation(s)
- J Brown
- Harlem Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY 10037
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Schmidt DR, Johns JP, Linville KW. Detection of intracavitary right ventricular polypoid masses due to metastatic lymphoma using contrast echocardiography. Am Heart J 1990; 120:446-9. [PMID: 2382627 DOI: 10.1016/0002-8703(90)90100-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- D R Schmidt
- Cardiology Service/SGHMMC, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236-5300
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