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Sun T, Lu GL, Ma LC, Huang JZ, Xie SB. Multimodal echocardiography in the diagnosis of masses localized to the proximal portions of pulmonary arteries. Int J Cardiovasc Imaging 2021; 38:149-158. [PMID: 34716510 DOI: 10.1007/s10554-021-02427-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
Proximal pulmonary artery masses are exceedingly rare, and their diagnosis and therapy are important and challenging for clinicians. This study reviews our experience exploring the value of a combination of transthoracic echocardiography and contrast echocardiography for the differential diagnosis of proximal pulmonary artery masses. Between January 2018 and June 2021, 44 patients diagnosed with a mass attached to the major pulmonary artery and straddling the bilateral pulmonary arteries or pulmonary valve on transthoracic echocardiography were referred to this study. Contrast echocardiography was performed in 17 patients. Masses were diagnosed based on their site of attachment, shape, size, mobility, hemodynamic consequences on transthoracic echocardiography, and tissue perfusion on contrast echocardiographic perfusion imaging. Pathological data were collected from medical records and analyzed. The most frequent location of proximal pulmonary artery masses was the major pulmonary artery trunk. Twelve patients underwent complete mass resection, whereas nine patients underwent percutaneous pulmonary artery biopsy puncture and had a pathological diagnosis. Another 24 patients were confirmed with the validation methods. Contrast echocardiography has good sensitivity and specificity for differentiating thrombi from pulmonary artery sarcomas (PAS). The mass types were distributed as follows: thrombi (19, 43%), PAS (15, 34%), metastatic tumors (6, 14%), vegetations (3, 7%), and primary benign lesions (1, 2%). The majority of proximal pulmonary artery masses were thrombi or PAS. A combination of transthoracic echocardiography and contrast echocardiography offers advantages in the early identification of proximal pulmonary masses and provides clinically important information about the characteristics of masses, especially for differentiating thrombi from PAS.
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Affiliation(s)
- Ting Sun
- Department of Ultrasonography, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guo-Liang Lu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151 Yanjiang West Road, Guangzhou, 510120, China
| | - Lun-Chao Ma
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151 Yanjiang West Road, Guangzhou, 510120, China
| | - Jie-Zhou Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151 Yanjiang West Road, Guangzhou, 510120, China
| | - Shao-Bo Xie
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151 Yanjiang West Road, Guangzhou, 510120, China.
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Cottini M, Pergolini A, Zampi G, Buffa V, Pino PG, Polizzi V, Ranocchi F, Luzi G, Montalto A, Musumeci F. Posterior wall as atypical localization of left atrial myxoma : Diagnosis and management. Herz 2016; 42:390-394. [PMID: 27752714 DOI: 10.1007/s00059-016-4480-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/06/2016] [Accepted: 08/07/2016] [Indexed: 10/20/2022]
Abstract
Atrial myxomas are the most common benign cardiac neoplasms. Although the majority occur in the left atrium (LA) and are attached to the interatrial septum (75-80 % of cases), they can arise from any part of the LA and the cardiac chambers. We report the case of a 65-year-old woman who presented with features of worsening dyspnea and persistent headache. During transthoracic echocardiography, a suspected cardiac myxoma was found arising from the posterior wall of the LA.
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Affiliation(s)
- M Cottini
- Department of Cardiovascular Science, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00149, Rome, Italy.
| | - A Pergolini
- Department of Cardiovascular Science, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00149, Rome, Italy
| | - G Zampi
- Department of Heart and Vessels, Cardiac Unit, Belcolle Hospital, 01100, Viterbo, Italy
| | - V Buffa
- Department of Cardiovascular Science, Radiology Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - P G Pino
- Department of Cardiovascular Science, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00149, Rome, Italy
| | - V Polizzi
- Department of Cardiovascular Science, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00149, Rome, Italy
| | - F Ranocchi
- Department of Cardiovascular Science, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00149, Rome, Italy
| | - G Luzi
- Department of Cardiovascular Science, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00149, Rome, Italy
| | - A Montalto
- Department of Cardiovascular Science, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00149, Rome, Italy
| | - F Musumeci
- Department of Cardiovascular Science, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00149, Rome, Italy
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Schaeffter T. Imaging modalities: principles and information content. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 2005; 62:15-81. [PMID: 16329254 DOI: 10.1007/3-7643-7426-8_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Tobias Schaeffter
- Philips Research Hamburg, Roentgenstr. 24-26, D-22335 Hamburg, Germany.
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Kirkpatrick JN, Wong T, Bednarz JE, Spencer KT, Sugeng L, Ward RP, DeCara JM, Weinert L, Krausz T, Lang RM. Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. J Am Coll Cardiol 2004; 43:1412-9. [PMID: 15093876 DOI: 10.1016/j.jacc.2003.09.065] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Revised: 08/26/2003] [Accepted: 09/09/2003] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated the usefulness of echocardiographic contrast perfusion imaging in differentiating cardiac masses. BACKGROUND Two-dimensional echocardiography is the primary diagnostic modality for cardiac masses. However, differentiation between the different types of cardiac masses may be difficult at times. We hypothesized that echocardiographic contrast perfusion imaging would differentiate the neo-vascularization of malignancies from the avascularity of thrombi and the sparse vascularity of stromal tumors. METHODS Sixteen patients with cardiac masses underwent power-modulation imaging after echocardiographic intravenous contrast administration. Pixel intensities in the mass and an adjacent section of myocardium were analyzed visually and by dedicated software. All masses had a pathologic diagnosis or resolved after anticoagulation. In a subset of patients, video-intensity curves of contrast replenishment in the mass and myocardium over time were generated. The post-impulse steady-state pixel intensity (A) and initial rate of contrast replenishment after impulse (beta) were compared with an index of blood vessel area on pathology. RESULTS In seven of 16 patients, contrast enhancement resulted in greater pixel intensity in the mass than in the adjacent myocardium. All of these masses were classified pathologically as malignant (n = 6) or benign and vascular (n = 1). Nine masses demonstrated decreased pixel intensity, compared with the myocardium, and were diagnosed pathologically as myxomas (n = 2) or thrombi (n = 5), or they resolved with anticoagulation (n = 2). For the subset of patients, beta correlated with the vessel area index (r = 0.60). CONCLUSIONS Echocardiographic contrast perfusion imaging aids in the differentiation of cardiac masses. Compared with the adjacent myocardium, malignant and vascular tumors hyper-enhanced, whereas stromal tumors and thrombi hypo-enhanced.
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Affiliation(s)
- James N Kirkpatrick
- Adult Noninvasive Cardiac Imaging Laboratories, Section of Cardiology, University of Chicago, Chicago, Illinois 60637, USA
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