Sudden death associated with cardiac inflammatory pseudotumour

Fatal Cardiac Tamponade Due to a Pericardial Inflammatory Myofibroblastic Tumor

The patient was a 34-year-old woman who suddenly collapsed. On arrival, she was in cardiac arrest. Cardiac ultrasound revealed cardiac tamponade; thus, urgent thoracotomy with pericardiotomy was performed. Spontaneous circulation was temporarily obtained; however, her circulation was not stabilized, and she ultimately died. An autopsy revealed a pericardial inflammatory myofibroblastic tumor (IMT) causing bloody cardiac tamponade. There were no signs of cardiac rupture, myocardial infarction or aortic dissection. We reported the first case of fatal bloody cardiac tamponade due to pericardial IMT in an adult. An autopsy is important for clarifying the etiology in cases of fatal cardiac tamponade of unknown cause.

A forensic autopsy case: Sudden unexpected death due to cardiac inflammatory myofibroblastic tumor

We report an autopsy case of a 25-year-old man with no medical history who died suddenly in an Internet cafe. He was found in cardiorespiratory arrest and did not respond to cardiopulmonary resuscitation. Traumatic lesions were not observed on his body. An autopsy was performed to investigate the cause of death. Upon examination, we discovered a heart tumor that infiltrated from the outside wall to the outflow tract of the left ventricle. Left ventricular outflow tract obstruction due to a cardiac tumor was considered the mechanism of death. Histological examination identified an inflammatory myofibroblastic tumor (IMT). The final diagnosis was death secondary to circulatory failure due to a cardiac IMT. Additionally, a cardiac tumor was diagnosed using post-mortem computed tomography. Only few cases of sudden unexpected death due to cardiac IMT have been reported; we report this case along with a review of the literature.

Cardiac Inflammatory Myofibroblastic Tumor

Although inflammatory myofibroblastic tumors (IMTs) can be found in virtually every major organ, cardiac origin is rare. After recently providing care to a child who presented with a significant myocardial infarction, interest in this rare tumor was piqued. We describe a comprehensive review of cardiac IMT, including information on nomenclature, epidemiology, clinical features, pathogenesis, gross/histological features, immunohistochemical profile, diagnosis, treatment, and prognosis. Fifty-seven cases were identified in the literature. Interestingly, our case represents the seventh case of coronary artery involvement reported. Moreover, it was found that an initial presentation of sudden death most commonly involves the coronary arteries.

Inflammatory myofibroblastic tumor of the aortic valves causing sudden cardiac death: a case report and review of the literature

Cardiac inflammatory myofibroblastic tumor (IMT) is a rare entity affecting predominantly infants, children, and young adults. Although most tumors have a benign clinical course after complete surgical resection, some have significant clinical effects. We report the case of a 9-year-old girl who had sudden cardiac death as a result of occlusion of the left circumflex coronary artery. A review of 57 cases of cardiac IMTs reported in the literature in terms of epidemiology, clinical presentation, histologic and immunohistologic features, and outcome is presented. Recognition of this rare abnormality is important in order to initiate prompt surgical intervention.

Myofibroblastic tumor of the right ventricle causing bilateral pulmonary embolism in a 31 year-old woman

The myofibroblastic tumor (MFT) is a very rare tumor, initially described in the lungs, and which involves exceptionally the heart. We report the unusual case of a 31 year-old female patient, in whom the tumor produced a bilateral pulmonary embolism and whose unique clinical demonstration was a longstanding fever. The tumor, located in the right ventricle, has been surgically completely excised with excellent results. We also make a review of literature of the various aspects of this pathology.

Intradural cervical inflammatory pseudotumor mimicking epidural hematoma in a pregnant woman: case report and review of the literature

BACKGROUND

Inflammatory pseudotumors usually affect the lung and the orbit. They occur extremely rarely in the spine. We encountered a case of intradural extramedullary IPT of the cervical spine in a pregnant woman that initially presented as an epidural hematoma in MRI.

CASE DESCRIPTION

This is a case of a 30-year-old, HIV-negative, full-term pregnant lady presenting with 2-month history of progressive quadriparesis with rapid worsening of power in all 4 limbs for 3 days. Magnetic resonance imaging scanning revealed cervical extramedullary compressive lesion likely to be epidural bleed from its imaging characteristics. Intraoperatively, intradural extramedullary granulomatous lesion was found with dural thickening. Gross total excision was accomplished; histopathologic study assessed an IPT. The patient improved after surgery excision and is doing well at 6-month follow-up with remarkable neurological recovery.

CONCLUSION

Cervical intradural IPT is a very rare issue in the spine. Diagnosis can be confused with a neoplastic lesion like an "en plaque meningioma" or as epidural bleed like in the present case.

Cardiac Inflammatory Myofibroblastic Tumor: A “Benign” Neoplasm That May Result in Syncope, Myocardial Infarction, and Sudden Death

Cardiac tumors other than myxomas are rare. We report a series of 10 intracavitary polypoid myofibroblastic proliferations in children and young adults emphasizing gross, histologic, and clinical features. There were 6 females and 4 males, with a mean age of 10 years (range 5 wk to 21 y). All lesions were endocardial-based, located in the right atrium (1), right ventricular inflow/tricuspid valve (1), right ventricular outflow (3), mitral valve (3), aortic valve/left coronary sinus (1), and left ventricular free wall (1). Symptoms included shortness of breath or dyspnea (3), syncope (2), chest pain (1), transient ischemic attacks (1), and fever with myalgias (1). All tumors were surgical resections, except 1 tumor that resulted in sudden coronary death and that was diagnosed at autopsy, and 1 tumor that embolized into the coronary artery and was treated by cardiac transplant. Two tumors, present in the aortic and mitral valves, respectively, caused cardiac ischemia. The tumors were polypoid or filiform and histologically resembled inflammatory myofibroblastic tumors of extracardiac sites, with loose spindle cell growth with sparse inflammation. Although there were frequent collagen bundles interspersed among the tumor cells, there were no large areas of dense fibrosis. Surface fibrin was present on the polypoid projections in 7 cases. Symptoms resulted from prolapse into coronary ostia or embolization, but no patient developed metastasis. Long-term follow-up in 2 patients demonstrated no evidence of disease or recurrence. Although metastatic potential was not identified, these tumors may result in serious symptoms, including myocardial infarct, syncope, and sudden death. These cardiac myofibroblastic tumors are readily distinguished from other endocardial-based cardiac tumors, including papillary fibroelastoma and myxoma, which may present clinically in the same manner.

Multiple Cardiac Inflammatory Myofibroblastic Tumors in the Right Ventricle in an Infant

Reported is the successful treatment of a 2-month-old boy with multiple inflammatory myofibroblastic tumors in the right ventricle protruding into the right atrium through the tricuspid annulus. The patient underwent subtotal excision on cardiopulmonary bypass with no intraoperative or postoperative complications. Cardiac inflammatory myofibroblastic tumors are rare lesions, and surgical resections in patients as young as 2 months have not been previously described. In this report we review the relevant literature and discuss the prevalence, histology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, and treatment of cardiac inflammatory myofibroblastic tumor.

An unusual cause of ventricular tachycardia

Inflammatory pseudotumour (IP) of the heart is an extremely uncommon and potentially fatal lesion which presents a challenging diagnosis even for the experienced pathologist, cardiologist and cardiac surgeon. This spindle cell tumour is known to be present in virtually every anatomical region but, in adults, has only previously been found in the heart at postmortem. We report the case of a 27-year-old man who presented with ventricular tachyarrhythmias and a right ventricular mass which was subsequently shown to be an IP.

Inflammatory myofibroblastic tumor of the left ventricle in an older adult

We report an unusual study of a 72-year-old woman who presented with a symptomatic space-occupying lesion in the left ventricle. The lesion was surgically excised with a good long-term result. It was histologicaly diagnosed as an inflammatory myofibroblastic tumor. Also known as an inflammatory pseudotumor, these tumors affecting the heart are extremely rare and occur mainly in children and adolescents. We review the literature and highlight the unique nature of the lesion.

Inflammatory pseudotumor of the heart causing aortic regurgitation

Inflammatory pseudotumor is a tumor-like reactive lesion of unknown etiology that rarely affects the heart. We describe an unusual case of a cardiac inflammatory pseudotumor that involved the aortic valve and caused regurgitation in a 62-year-old man. The lesion was excised and the aortic valve was replaced, resulting in a favorable outcome for the patient.

Tuberculous myocarditis presenting as sudden cardiac death

A 71-year-old Chinese male presented as sudden death and autopsy revealed miliary tuberculosis with tuberculous myocarditis. Though miliary tuberculosis is not as common as in the past, it remains one of the possible causes of sudden cardiac death.