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Roset-Altadill A, Domenech-Ximenos B, Cañete N, Juanpere S, Rodriguez-Eyras L, Hidalgo A, Vargas D, Pineda V. Epicardial Space: Comprehensive Anatomy and Spectrum of Disease. Radiographics 2024; 44:e230160. [PMID: 38483831 DOI: 10.1148/rg.230160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The epicardial space (ES) is the anatomic region located between the myocardium and the pericardium. This space includes the visceral pericardium and the epicardial fat that contains the epicardial coronary arteries, cardiac veins, lymphatic channels, and nerves. The epicardial fat represents the main component of the ES. This fat deposit has been a focus of research in recent years owing to its properties and relationship with coronary gossypiboma plaque and atrial fibrillation. Although this region is sometimes forgotten, a broad spectrum of lesions can be found in the ES and can be divided into neoplastic and nonneoplastic categories. Epicardial neoplastic lesions include lipoma, paraganglioma, metastases, angiosarcoma, and lymphoma. Epicardial nonneoplastic lesions encompass inflammatory infiltrative disorders, such as immunoglobulin G4-related disease and Erdheim-Chester disease, along with hydatidosis, abscesses, coronary abnormalities, pseudoaneurysms, hematoma, lipomatosis, and gossypiboma. Initial imaging of epicardial lesions may be performed with echocardiography, but CT and cardiac MRI are the best imaging modalities to help characterize epicardial lesions. Due to the nonspecific onset of signs and symptoms, the clinical history of a patient can play a crucial role in the diagnosis. A history of malignancy, multisystem diseases, prior trauma, myocardial infarction, or cardiac surgery can help narrow the differential diagnosis. The diagnostic approach to epicardial lesions should be made on the basis of the specific location, characteristic imaging features, and clinical background. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Adria Roset-Altadill
- From the Department of Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Av França S/N, 17007, Girona, Spain (A.R.A., N.C., S.J., A.H., V.P.); Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X.); Department of Cardiology, Clinica Colon, Buenos Aires, Argentina (L.R.E.); and Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.)
| | - Blanca Domenech-Ximenos
- From the Department of Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Av França S/N, 17007, Girona, Spain (A.R.A., N.C., S.J., A.H., V.P.); Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X.); Department of Cardiology, Clinica Colon, Buenos Aires, Argentina (L.R.E.); and Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.)
| | - Noemi Cañete
- From the Department of Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Av França S/N, 17007, Girona, Spain (A.R.A., N.C., S.J., A.H., V.P.); Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X.); Department of Cardiology, Clinica Colon, Buenos Aires, Argentina (L.R.E.); and Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.)
| | - Sergi Juanpere
- From the Department of Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Av França S/N, 17007, Girona, Spain (A.R.A., N.C., S.J., A.H., V.P.); Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X.); Department of Cardiology, Clinica Colon, Buenos Aires, Argentina (L.R.E.); and Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.)
| | - Lucia Rodriguez-Eyras
- From the Department of Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Av França S/N, 17007, Girona, Spain (A.R.A., N.C., S.J., A.H., V.P.); Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X.); Department of Cardiology, Clinica Colon, Buenos Aires, Argentina (L.R.E.); and Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.)
| | - Alberto Hidalgo
- From the Department of Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Av França S/N, 17007, Girona, Spain (A.R.A., N.C., S.J., A.H., V.P.); Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X.); Department of Cardiology, Clinica Colon, Buenos Aires, Argentina (L.R.E.); and Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.)
| | - Daniel Vargas
- From the Department of Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Av França S/N, 17007, Girona, Spain (A.R.A., N.C., S.J., A.H., V.P.); Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X.); Department of Cardiology, Clinica Colon, Buenos Aires, Argentina (L.R.E.); and Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.)
| | - Victor Pineda
- From the Department of Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Av França S/N, 17007, Girona, Spain (A.R.A., N.C., S.J., A.H., V.P.); Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain (B.D.X.); Department of Cardiology, Clinica Colon, Buenos Aires, Argentina (L.R.E.); and Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.)
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Mori S, Bertamino M, Guerisoli L, Stratoti S, Canale C, Spallarossa P, Porto I, Ameri P. Pericardial effusion in oncological patients: current knowledge and principles of management. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:8. [PMID: 38365812 PMCID: PMC10870633 DOI: 10.1186/s40959-024-00207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND This article provides an up-to-date overview of pericardial effusion in oncological practice and a guidance on its management. Furthermore, it addresses the question of when malignancy should be suspected in case of newly diagnosed pericardial effusion. MAIN BODY Cancer-related pericardial effusion is commonly the result of localization of lung and breast cancer, melanoma, or lymphoma to the pericardium via direct invasion, lymphatic dissemination, or hematogenous spread. Several cancer therapies may also cause pericardial effusion, most often during or shortly after administration. Pericardial effusion following radiation therapy may instead develop after years. Other diseases, such as infections, and, rarely, primary tumors of the pericardium complete the spectrum of the possible etiologies of pericardial effusion in oncological patients. The diagnosis of cancer-related pericardial effusion is usually incidental, but cancer accounts for approximately one third of all cardiac tamponades. Drainage, which is mainly attained by pericardiocentesis, is needed when cancer or cancer treatment-related pericardial effusion leads to hemodynamic impairment. Placement of a pericardial catheter for 2-5 days is advised after pericardial fluid removal. In contrast, even a large pericardial effusion should be conservatively managed when the patient is stable, although the best frequency and timing of monitoring by echocardiography in this context are yet to be established. Pericardial effusion secondary to immune checkpoint inhibitors typically responds to corticosteroid therapy. Pericardiocentesis may also be considered to confirm the presence of neoplastic cells in the pericardial fluid, but the yield of cytological examination is low. In case of newly found pericardial effusion in individuals without active cancer and/or recent cancer treatment, a history of malignancy, unremitting or recurrent course, large effusion or presentation with cardiac tamponade, incomplete response to empirical therapy with nonsteroidal anti-inflammatory, and hemorrhagic fluid at pericardiocentesis suggest a neoplastic etiology.
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Affiliation(s)
- S Mori
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - M Bertamino
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - L Guerisoli
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - S Stratoti
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - C Canale
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - P Spallarossa
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - I Porto
- Department of Internal Medicine, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - P Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy.
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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Wang Z, Ma B, Nie F. Prenatal diagnosis of fetal pericardial rhabdomyoma resulting in fetal death. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2483-2485. [PMID: 37776385 DOI: 10.1007/s10554-023-02954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/07/2023] [Indexed: 10/02/2023]
Abstract
We present a case of huge pericardial rhabdomyoma that progressed into the pericardial cavity, resulting in fetal death. Fetal ultrasound and neonatal echocardiography provide excellent diagnostic methods for fetal rhabdomyoma. When established, antenatal diagnosis enables a focused, specialized, and multidisciplinary approach with individual case management, potentially reducing perinatal morbidity and mortality.
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Affiliation(s)
- Zhen Wang
- Ultrasound Medicine Center, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu Province, 730030, China
| | - Bin Ma
- Ultrasound Medicine Center, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu Province, 730030, China
| | - Fang Nie
- Ultrasound Medicine Center, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu Province, 730030, China.
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Tombelli S, Viggiano D, Salvicchi A, Bongiolatti S, Gonfiotti A, Voltolini L. Presentation and treatment of two massive intrapericardial lipoma. Case report. Int J Surg Case Rep 2023; 111:108851. [PMID: 37738826 PMCID: PMC10523423 DOI: 10.1016/j.ijscr.2023.108851] [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: 08/05/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary pericardial tumors are very rare with an overall incidence of 0.001-0.007 % and account for approximately 10 % of heart neoplasms. We present two clinical cases of massive mature intrapericardial lipomas (maximum size 270 × 230 mm) that were successfully treated in our department. CASE PRESENTATION The first case is that of a 67-year-old male patient who underwent diagnostic investigations after the onset of dyspnea, which confirmed an intrapericardial mass of 270 × 230 mm in size that extended into the left lung field and was treated surgically by a clamshell incision. The second case is that of a 48-year-old patient who was completely asymptomatic and occasionally confirmed to have a 170 × 110 mm intrapericardial mass around the heart, which was surgically removed via sternotomy, also resulting in a mature lipoma. CLINICAL DISCUSSION In asymptomatic patients with small lesions, close monitoring is generally indicated. In asymptomatic patients with large lesions the decision should be made after multidisciplinary (MDT) evaluation. In symptomatic patients, surgical treatment is indicated. Lipomas are usually mature lesions with a capsule connected to the origin structure by one or more pedicles. Once reached the cardiac level and opened the pericardium, attention must be paid in resecting these pedicles given the area of origin and the possibility that they may be associated with vital structures. CONCLUSION Both cases were characterized by slow recovery of normal cardiac function in the postoperative course. The average length of patient stay was 12 days, and one case was noted for readmission because a slight increase in pericardial effusion was detected at the scheduled ultrasound check after discharge. After further expert evaluation and steriodine therapy, the patient was discharged to a healthy home after 5 days. This report aims to describe the decision-making process, successful surgical treatment and outcomes of two rare massive intrapericardial tumors.
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Affiliation(s)
- Simone Tombelli
- Division of Thoracic Surgery, Careggi University Hospital, Florence, Italy.
| | - Domenico Viggiano
- Division of Thoracic Surgery, Careggi University Hospital, Florence, Italy
| | - Alberto Salvicchi
- Division of Thoracic Surgery, Careggi University Hospital, Florence, Italy
| | | | | | - Luca Voltolini
- Division of Thoracic Surgery, Careggi University Hospital, Florence, Italy
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Medina Perez M, Lichtenberger JP, Huppmann AR, Gomez M, Ramirez Suarez KI, Foran A, Vaiyani D, White AM, Biko DM. Cardiac and Pericardial Neoplasms in Children: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e230010. [PMID: 37561644 DOI: 10.1148/rg.230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Primary cardiac and pericardial neoplasms are rare in the pediatric population and can include both benign and malignant lesions. Rhabdomyomas, teratomas, fibromas, and hemangiomas are the most common benign tumors. The most common primary cardiac malignancies are soft-tissue sarcomas, including undifferentiated sarcomas, rhabdomyosarcomas, and fibrosarcomas. However, metastatic lesions are more common than primary cardiac neoplasms. Children with primary cardiac and pericardial tumors may present with nonspecific cardiovascular symptoms, and their clinical presentation may mimic that of more common nonneoplastic cardiac disease. The diagnosis of cardiac tumors has recently been facilitated using noninvasive cardiac imaging. Echocardiography is generally the first-line modality for evaluation. Cardiac MRI and CT are used for tissue characterization and evaluation of tumor size, extension, and physiologic effect. The varied imaging appearances of primary cardiac neoplasms can be explained by their underlying abnormality. Treatment of these lesions varies from conservative management, with spontaneous regression of some lesions such as rhabdomyomas, to surgical resection, particularly in patients with associated heart failure. With adequate imaging techniques and knowledge of the pathologic basis of the neoplasm, it is often possible to differentiate benign from malignant tumors, which can greatly affect adequate and timely treatment. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Mariangeles Medina Perez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - John P Lichtenberger
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Alison R Huppmann
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Mariangela Gomez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Karen I Ramirez Suarez
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Ann Foran
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Danish Vaiyani
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Ammie M White
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
| | - David M Biko
- From the Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (M.M.P.); Sections of Thoracic Radiology (J.P.L.) and Pediatric Radiology (D.M.B.), American College of Radiology Institute of Radiologic Pathology, Silver Spring, Md; Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Pathology, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); Department of Pathology, MD Anderson Cancer Center, Houston, Tex (M.G.); and Department of Radiology (K.I.R.S., A.F., A.M.W., D.M.B.) and Division of Cardiology (D.V.), Children's Hospital of Philadelphia, Philadelphia, Penn
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Li X, Cao Y, Shao G, Cui Y, Li Y, Zhang K, Liu X, Shi H. Multimodality imaging assessment of primary pericardial rhabdomyosarcoma: a case report. Front Cardiovasc Med 2023; 10:1237951. [PMID: 37645522 PMCID: PMC10461312 DOI: 10.3389/fcvm.2023.1237951] [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: 06/10/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Primary pericardial sarcomas are rare and lethal diseases. To date, only a few cases of primary pericardial sarcomas, such as rhabdomyosarcoma (RMS), have been reported. Since the unusual location of RMS in the pericardium makes it challenging to diagnose, precise diagnostic procedures are required. In this study, we present the case of a 23-year-old man who experienced postprandial obstruction and atypical precordial pain that lasted for a week. Echocardiography revealed a heterogeneous isoechoic pericardial mass with a significant pericardial effusion. Contrast-enhanced CT revealed a massive pericardial effusion along with an irregular, defined, heterogeneously enhancing mass that was located between the pericardium and diaphragm. PET-CT imaging showed an intense FDG uptake in the pericardial mass. Furthermore, cardiac MRI demonstrated malignant characteristics of the pericardial mass and provided a detailed visualization of its exact anatomical connection with both cardiac and extracardiac structures. Finally, a pathologic examination of a puncture biopsy specimen confirmed the diagnosis of primary pericardial RMS. Our case emphasizes the importance of multimodal imaging for the differential diagnosis and evaluation of cardiac involvement, while providing clinicians with crucial information for clinical treatment and decision-making.
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Affiliation(s)
- Xingxuan Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yukun Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guozhu Shao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Cui
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yumin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kailu Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqing Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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7
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Mirdamadi A, Sadeghi AM, Sadeghi MM, Rabani M, Hassanzadeh S. Para-Cardiac Inflammatory Mass Compressing the Heart: A possible association with COVID-19. Sultan Qaboos Univ Med J 2023; 23:411-414. [PMID: 37655079 PMCID: PMC10467551 DOI: 10.18295/squmj.8.2022.051] [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: 11/25/2021] [Revised: 04/19/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Infection with the SARS-CoV-2 virus causes coronavirus disease 2019 (COVID-19). COVID-19 usually affects the lungs but may also involve other organs such as the heart. We report a case of a para-cardiac mass in a previously healthy 45-year-old male who developed persistent dyspnea following SARS-CoV-2 infection. The patient underwent cardiac surgery since the mass was attached to the pericardium and was causing constrictive pericarditis. The pathology report indicated an inflammatory pattern for the mass. Based on the authors' knowledge there has been no previous report of developing a para-cardiac inflammatory mass after SARS-CoV-2 infection. This report aimed to increase awareness regarding the possibility of developing a para-cardiac inflammatory mass following COVID-19.
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Affiliation(s)
- Ahmad Mirdamadi
- Department of Cardiology, Medical School, Islamic Azad University, Najafabad Branch, Isfahan, Iran
| | - Amir M.M. Sadeghi
- Department of Cardiovascular Surgery, Chamran Heart Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen M.M. Sadeghi
- Department of Cardiac Surgery, Chamran Heart Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rabani
- Cardiac Ward, Khanevadeh Hospital, Isfahan, Iran
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Reddy P, Kane GC, Oh JK, Luis SA. The Evolving Etiologic and Epidemiologic Portrait of Pericardial Disease. Can J Cardiol 2023; 39:1047-1058. [PMID: 37217161 DOI: 10.1016/j.cjca.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
Pericardial disease includes a variety of conditions, including inflammatory pericarditis, pericardial effusions, constrictive pericarditis, pericardial cysts, and primary and secondary pericardial neoplasms. The true incidence of this varied condition is not well established, and the causes vary greatly across the world. This review aims to describe the changing pattern of epidemiology of pericardial disease and to provide an overview of causative etiologies. Idiopathic pericarditis (assumed most often to be viral) remains the most common etiology for pericardial disease globally, with tuberculous pericarditis being most common in developing countries. Other important etiologies include fungal, autoimmune, autoinflammatory, neoplastic (both benign and malignant), immunotherapy-related, radiation therapy-induced, metabolic, postcardiac injury, postoperative, and postprocedural causes. Improved understanding of the immune pathophysiological pathways has led to identification and reclassification of some idiopathic pericarditis cases into autoinflammatory etiologies, including immunoglobulin G (IgG)4-related pericarditis, tumour necrosis factor receptor-associated periodic syndrome (TRAPS), and familial Mediterranean fever in the current era. Contemporary advances in percutaneous cardiac interventions and the recent COVID-19 pandemic have also resulted in changes in the epidemiology of pericardial diseases. Further research is needed to improve our understanding of the etiologies of pericarditis, using the assistance of contemporary advanced imaging techniques and laboratory testing. Careful consideration of the range of potential causes and local epidemiologic patterns of causality are important for the optimization of diagnostic and therapeutic approaches.
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Affiliation(s)
- Prajwal Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Abstract
Primary pericardial mesothelioma (PM) is a rare tumor arising from the mesothelial cells of the pericardium. It has an incidence of <0.05% and comprises <2% of all mesotheliomas; however, it is the most common primary malignancy of the pericardium. PM should be distinguished from secondary involvement by the spread of pleural mesothelioma or metastases, which are more common. Although data are controversial, the association between asbestos exposure and PM is less documented than that with other mesotheliomas. Late clinical presentation is common. Symptoms may be nonspecific but are usually related to pericardial constriction or cardiac tamponade, and diagnosis can be challenging usually requiring multiple imaging modalities. Echocardiography, computed tomography, and cardiac magnetic resonance demonstrate heterogeneously enhancing thickened pericardium, usually encasing the heart, with findings of constrictive physiology. Tissue sampling is essential for diagnosis. Histologically, similar to mesotheliomas elsewhere in the body, PM is classified as epithelioid, sarcomatoid, or biphasic, with the biphasic type being the most common. Combined with morphologic assessment, the use of immunohistochemistry and other ancillary studies is helpful for distinguishing mesotheliomas from benign proliferative processes and other neoplastic processes. The prognosis of PM is poor with about 22% 1-year survival. Unfortunately, the rarity of PM poses limitations for comprehensive and prospective studies to gain further insight into the pathobiology, diagnosis, and treatment of PM.
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10
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Suthar PP, Kounsal A, Chhetri L, Mehta CM, Ansari SM, Shingade R. Pericardial Cyst at an Unusual Location: The Role of CT Imaging. Cureus 2023; 15:e42403. [PMID: 37637666 PMCID: PMC10447228 DOI: 10.7759/cureus.42403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
The pericardial cyst is a benign, uncommon congenital cystic lesion of pericardial origin located in the anterior and middle mediastinum. Most commonly, pericardial cysts are located in the right anterior cardiophrenic angle. Computed tomography (CT) and magnetic resonance imaging (MRI) of the chest are the non-invasive imaging modalities for the diagnosis of the pericardial cyst. Here we present a case of a 55-year-old male who presented with coughing and chest pain for two weeks. A chest X-ray revealed a soft-tissue opacity mass in the left lower zone. A CT of the chest showed a fluid-density cystic lesion in close proximity to the pericardium, located along the left posterior cardiophrenic angle, an uncommon location for a pericardial cyst.
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Affiliation(s)
- Pokhraj P Suthar
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, USA
| | - Avin Kounsal
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, USA
| | - Lavanya Chhetri
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, USA
| | - Chetankumar M Mehta
- Department of Radiodiagnosis, Sir Sayaji General Hospital & Medical College Baroda, Vadodara, IND
| | - Shehbaz M Ansari
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, USA
| | - Raman Shingade
- Radiology, Nidan Diagnostic and Research Center, Bhubaneswar, IND
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11
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Strange CD, Marom EM, Ahuja J, Shroff GS, Gladish GW, Carter BW, Truong MT. Imaging of Malignant Pleural, Pericardial, and Peritoneal Mesothelioma. Adv Anat Pathol 2023; 30:280-291. [PMID: 36395181 DOI: 10.1097/pap.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Malignant mesothelioma is a rare tumor arising from the mesothelial cells that line the pleura, pericardium, peritoneum, and tunica vaginalis. Imaging plays a primary role in the diagnosis, staging, and management of malignant mesothelioma. Multimodality imaging, including radiography, computed tomography (CT), magnetic resonance imaging (MRI), and F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), is used in a variety of scenarios, including diagnosis, guidance for tissue sampling, staging, and reassessment of disease after therapy. CT is the primary imaging modality used in staging. MRI has superior contrast resolution compared with CT and can add value in terms of determining surgical resectability in equivocal cases. MRI can further assess the degree of local invasion, particularly into the mediastinum, chest wall, and diaphragm, for malignant pleural and pericardial mesotheliomas. FDG PET/CT plays a role in the diagnosis and staging of malignant pleural mesothelioma (MPM) and has been shown to be more accurate than CT, MRI, and PET alone in the staging of malignant pleural mesothelioma. PET/CT can also be used to target lesions for biopsy and to assess prognosis, treatment response, and tumor recurrence.
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Affiliation(s)
- Chad D Strange
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Radiology, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory W Gladish
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brett W Carter
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Li GY, Hong JL, Wang SY, Xie Z, Liu ET, Wang SX. Pericardial paraganglioma detected with contrast-enhanced CT, MRI, and 18F-FDG PET/CT findings. J Nucl Cardiol 2023; 30:835-838. [PMID: 34877638 DOI: 10.1007/s12350-021-02872-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Guang-Yu Li
- Department of Radiology, Luoding People's Hospital, Luoding, Guangdong, China
| | - Ju-Lu Hong
- Department of Radiology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Si-Yun Wang
- Department of Nuclear Medicine, WeiLun PET Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Room 526, 5/F, Weilun Building of Guangdong Provincial People's Hospital, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
| | - Zhi Xie
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - En-Tao Liu
- Department of Nuclear Medicine, WeiLun PET Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Room 526, 5/F, Weilun Building of Guangdong Provincial People's Hospital, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China.
| | - Shu-Xia Wang
- Department of Nuclear Medicine, WeiLun PET Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Room 526, 5/F, Weilun Building of Guangdong Provincial People's Hospital, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, China
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13
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Hong A, Steen C, Wong E, Cochrane AD. Pericardial cystic teratoma. ANZ J Surg 2023; 93:695-696. [PMID: 35775405 DOI: 10.1111/ans.17891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Alton Hong
- Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Christopher Steen
- Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Enoch Wong
- Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew D Cochrane
- Monash Health and Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Bonde A, Singh R, Prasad SR, Kamireddy D, Aggarwal A, Ramani N, Saboo S, Shanbhogue K, Dasyam AK, Katabathina VS. Mesotheliomas and Benign Mesothelial Tumors: Update on Pathologic and Imaging Findings. Radiographics 2023; 43:e220128. [PMID: 36757881 DOI: 10.1148/rg.220128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
A diverse spectrum of benign entities and malignant neoplasms originate from the monotonous mesothelium that lines the serosal membranes of the pleural, pericardial, and peritoneal cavities. The mesothelium of myriad sites shows a common origin from the lateral plate mesoderm; primary mesothelial tumors thus demonstrate similar pathogenesis, imaging findings, and treatment options. Significant changes have been made in the 2021 World Health Organization (WHO) classification schemata of the pleural and pericardial tumors on the basis of recent advances in pathology and genetics. While malignant mesotheliomas are biologically aggressive malignancies that occur primarily in patients exposed to asbestos with attendant poor survival rates, well-differentiated papillary mesothelial tumors and adenomatoid tumors charter a benign clinical course with an excellent prognosis. Mesothelioma in situ is a newly characterized entity represented by recurrent unexplained pleural effusions without any identifiable mass at imaging or thoracoscopy. Immunohistochemical markers based on BAP1, MTAP, CDKN2A, and TRAF7 gene mutations help differentiate diffuse mesotheliomas from benign mesothelial proliferations and localized mesotheliomas. Cross-sectional imaging modalities, including US, CT, MRI, and fluorine 18-fluorodeoxyglucose (FDG) PET/CT, permit diagnosis and play a major role in staging and assessing surgical resectability. Imaging studies are invaluable in providing noninvasive and quantitative assessment of tumor response in patients with unresectable disease. Owing to significant overlap in patient characteristics and pathomorphology, accurate diagnosis based on advanced histopathology techniques and genetic abnormalities is imperative for optimal management and prognostication. While patients with nonepithelioid pleural mesotheliomas benefit from immunotherapy, novel targeted therapies for CDKN2A-, NF2-, and BAP1-altered mesotheliomas are under consideration. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Apurva Bonde
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Ramandeep Singh
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Dhiraj Kamireddy
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Aarushi Aggarwal
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Nisha Ramani
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Sachin Saboo
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Krishna Shanbhogue
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Anil K Dasyam
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
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15
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Higashimoto N, Ota S, Murata S, Nishimura Y, Tanaka A. Pericardial Lipoma With Fat Necrosis. JACC Case Rep 2022; 4:101677. [PMID: 36438433 PMCID: PMC9681664 DOI: 10.1016/j.jaccas.2022.10.010] [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: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
A pericardial lipoma is a rare benign cardiac tumor, and fat necrosis is an uncommon clinical condition. This is the first reported case of pericardial lipoma with fat necrosis, which showed clinical presentations of a malignant tumor despite imaging findings consistent with benign lipoma. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Natsuki Higashimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shinichi Murata
- Departments of Human Pathology and Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
| | - Yoshiharu Nishimura
- Department of Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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16
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Utrera-Costero A, Bernal-Vergara JC, Olivan-Sasot P, Yepes-Agudelo AM, Ruiz-Llorca C, Vera-Pinto VJ, Bello-Arqués P. The value of 18F-FDG PET/CT in two cases of Primary Pericardial Mesothelioma. J Nucl Cardiol 2022; 29:3604-3607. [PMID: 34228336 DOI: 10.1007/s12350-021-02690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Ana Utrera-Costero
- Departament of Nuclear Medicine, Hospital Universitari i Politècnic La Fe, 46026, Valencia, España.
| | | | - Patricia Olivan-Sasot
- Departament of Nuclear Medicine, Hospital Universitario de la Ribera (Alcira), Valencia, España
| | - Ana María Yepes-Agudelo
- Departament of Nuclear Medicine, Hospital Universitari i Politècnic La Fe, 46026, Valencia, España
| | - Cristina Ruiz-Llorca
- Departament of Nuclear Medicine, Hospital Universitari i Politècnic La Fe, 46026, Valencia, España
| | - Victor José Vera-Pinto
- Departament of Nuclear Medicine, Hospital Universitari i Politècnic La Fe, 46026, Valencia, España
| | - Pilar Bello-Arqués
- Departament of Nuclear Medicine, Hospital Universitari i Politècnic La Fe, 46026, Valencia, España
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17
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Right Heart Failure as an Atypical Presentation of Chronic Type A Aortic Dissection - Multimodality Imaging for Accurate Diagnosis and Treatment. A case report and mini-review of literature. J Crit Care Med (Targu Mures) 2022; 8:204-213. [PMID: 36062037 PMCID: PMC9396954 DOI: 10.2478/jccm-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background An intrapericardial organized haematoma secondary to chronic type A aortic dissection is an extremely rare cause of right heart failure. Imaging studies are essential in recognising and diagnosis of this distinctive medical condition and guiding the anticipated treatment. Case presentation A 70-year-old male patient was admitted for progressive symptoms of right heart failure. His cardiovascular history exposed an aortic valve replacement 22 years before with a Medtronic Hall 23 tilting valve with no regular follow-up. Classical signs of congestion were recognized at physical examination. Transthoracic two-dimensional echocardiography and thoraco-abdominal computed tomography angiography, as essential parts of multimodality imaging algorithm, established the underlying cause of right heart failure. Under total cardiopulmonary bypass and cardiac arrest, surgical removal of the haematoma and proximal repair of the ascending aorta with a patient-matched vascular graft were successfully performed. The patient was discharged in good condition with appropriate pharmacological treatment, guideline-directed; no imagistic signs of acute post-surgery complications were ascertained. Conclusion This paper highlights the importance of recognizing and providing a timely clinical and imagistic diagnosis of this very rare, potentially avoidable cause of right heart failure in patients with previous cardiac surgery.
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18
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Ibrahim R, Yadav S, Waqar S, Hermann JR, Sarwar A, Shah S. Superior Vena Cava Syndrome Due to Right Anterior Mediastinal Hematoma: A Case Report. Cureus 2022; 14:e26994. [PMID: 35989818 PMCID: PMC9385572 DOI: 10.7759/cureus.26994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
The superior vena cava syndrome (SVCS) has been frequently reported to be secondary to malignancy, specifically, small cell bronchogenic carcinoma and non-Hodgkin's lymphoma. There is some data suggesting causes like postprocedural hematomas. We aim to describe a case of a patient who developed SVCS secondary to a mediastinal hematoma secondary to epicardial pacer leads (postprocedural). Our case is about a 75-year-old male with a past medical history of coronary artery disease and coronary artery bypass graft (CABG) who presented to the Emergency Department (ED) with moderate-to-severe right axillary pain radiating to the ipsilateral side of the neck, arm, and chest, associated to right temporal headache. A computed tomography angiography (CTA) of the chest was indicated at the time and revealed a hematoma with an active extravasation within the right superior anterior mediastinum, outside the pericardium. The patient was admitted to the Cardiovascular Intensive Care Unit (CVICU) and was started on nicardipine as his blood pressure in the ED was 217/125 and remained elevated despite proper pain management. A repeat CT scan of the chest showed a regressing hematoma that coincided with an improvement of the symptoms. This case highlights the importance of the complications of anterior mediastinal hematoma. The superior vena cava syndrome can develop after cardiologic procedures, after the implantation of devices. Prompt clinical diagnosis, including imaging, and treatment are necessary to manage this condition.
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19
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Machraa A, El Ghiati H, Fehri ZF, Mbida C, Chahdi H, Nya F, Moutakillah Y, Lakhal Z, Mouine N, Benyass A. A case report of a primary pericardial leiomyosarcoma: An extremely rare cardiac neoplasm. Ann Med Surg (Lond) 2022; 77:103701. [PMID: 35638054 PMCID: PMC9142710 DOI: 10.1016/j.amsu.2022.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Primary malignant pericardial tumors are an entity that is infrequently encountered and may be a cause of pericardial effusion. Primary pericardial leiomyosarcoma are even rarer, and highly aggressive tumors, with no more than 200 cases reported in the literature. In this case report, we are presenting a rare case of a primary pericardial leiomyosarcoma that was diagnosed at our institution. We discuss the available diagnostic modalities and also shed light on alternative therapies when patients are not ideal surgical candidates. Case presentation A 27-year-old male patient was admitted with a gradually worsening dyspnea associated with a deterioration of general condition. Echocardiography examination showed a circumferentiel pericardial effusion with significant fibrin deposits and pericardial thickening. An open surgical biopsy of the pericardium was indicated which was in favor of the diagnosis of pericardial leiomyosarcoma. Unfortunately, the patient died during the procedure. Clinical discussion Despite its rarity, primary pericardial leiomyosarcoma should be considered as a differential diagnosis in the assessment of a pericardial effusion of an unknown etiology. Cardiac magnetic resonance imaging is considered to be the reference standard technique for evaluation of a suspected pericardial tumor. Surgical biopsies provide the best odds for detection of the cell of origin, but it's fought with periprocedural risks depending on the site of the tumor. Conclusion Primary pericardial leiomyosarcomas appear to have a poor prognosis. Surgical approach is the primary modality of treatment. Chemotherapy and radiotherapy should be offered to patients who are not ideal surgical candidates. Pericardial leiomyosarcomas are rare and highly aggressive tumors. The prognosis is poor with 5-year survival rate of 14%. Multimodality imaging has enabled identification of the etiology of pericardial tumors in many cases. Surgical approach remains the gold standard of the therapy. Chemotherapy and radiotherapy are suitable alternatives.
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20
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Hajsadeghi S, Iranpour A, Amouei E, Tehrani NH, Ghavidel A, Ziaie H, Asadi O, Moradians V, Tayebi A, Mestres CA, Manqoutaei SA. Primary and metastatic primitive neuroectodermal tumor of the heart: A systematic review. Asian Cardiovasc Thorac Ann 2022; 30:761-771. [PMID: 35306869 DOI: 10.1177/02184923221083434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Primary and metastatic primitive neuroectodermal tumors of the pericardium are uncommon. Two cases are presented and discussed. METHODS The cases of a 17- and 38-year-old male patients with neuroectodermal tumors of the pericardium are presented. In addition, a systematic review was performed according to the Preferred Reporting Items and checklist for Systematic reviews and Meta-Analyses (PRISMA). All selected articles' quality assessment was done using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. RESULTS The systematic review yielded 29 patients with primary or metastatic PNET. Two patients underwent cardiac transplantation. It seems that unlike considering total resection in other organs, pericardiectomy in PNET patients with pericardial origin may lead to further invasion of the lesions, and it is not recommended. The average disease-free follow-up was 10 months. The combination of neoadjuvant and adjuvant chemotherapy along with surgery and radiotherapy offered the best disease-free outcomes. CONCLUSION Neuroectodermal heart tumors are rare, aggressive tumors requiring chemotherapy and radiotherapy in association with tumor resection surgery to have the best disease-free duration.
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Aida Iranpour
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Erfan Amouei
- Department of Internal Medicine, 440827Iran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Ghavidel
- Rajaie Cardiovascular Medical & Research Center, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ziaie
- Department of Internal Medicine, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Omolbanin Asadi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, 440827Iran University of Medical Sciences; Tehran, Iran
| | - Vahan Moradians
- Department of Pulmonology and Critical Care, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Ali Tayebi
- Department of Surgery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Carlos-A Mestres
- Department of Cardiac Surgery, 536392University Hospital Zürich, Zürich, Switzerland
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21
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Apicella G, Boulemden A, Citarella A, Sushma R, Szafranek A. Surgical treatment of a primary malignant pericardial mesothelioma: case report. Acta Chir Belg 2022; 122:48-50. [PMID: 32106775 DOI: 10.1080/00015458.2020.1736869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pericardial malignant mesothelioma (MM) is a rare tumour which accounts for about 1% of all mesotheliomas, 4% of the primary heart and pericardial tumours. It carries an extremely poor prognosis, with a reported overall survival of less than 6 months. Clinical symptoms and signs are frequently nonspecific, and the diagnosis is usually made after surgery or at autopsy. We report a case of a 72 years old woman with primary pericardial malignant mesothelioma involving the right atrium. Nine months following surgery, the patient is alive with good performance status.
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Affiliation(s)
- G. Apicella
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - A. Boulemden
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - A. Citarella
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - R. Sushma
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - A. Szafranek
- Department of Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
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22
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Benign Pericardial Hemangioma-A Rare Cause of Cardiac Tamponade. Indian J Radiol Imaging 2021; 31:754-757. [PMID: 34790331 PMCID: PMC8590538 DOI: 10.1055/s-0041-1736405] [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] [Indexed: 11/06/2022] Open
Abstract
Pericardial tumors are very rare. It can be primary or secondary, of which secondary tumors are more common. Pericardial hemangiomas are extremely rare primary neoplasms and there are only very few cases published in the literature. These patients can be asymptomatic. When symptomatic, they present with dyspnea, palpitation, or atypical chest pain. Severity of symptoms depends on the size and location of the tumor. Pericardial effusion with features of cardiac tamponade can lead to a life-threatening situation. Here, we report a case of pericardial hemangioma in a patient who presented with breathlessness and tamponade which was diagnosed preoperatively with computed tomography.
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23
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Leonte RM, Lucaci LV, Vlad CE, Florea A, Florea L. Atrial fibrillation, end-stage renal disease and hemorrhagic pleural-pericarditis. Arch Clin Cases 2021; 6:103-108. [PMID: 34754917 PMCID: PMC8565713 DOI: 10.22551/2019.25.0604.10162] [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] [Indexed: 11/25/2022] Open
Abstract
Pericarditis is the most common pericardial disease found in clinical practice, with an incidence of acute pericarditis reported in 27.7 cases per 100,000 subjects per year. Hemodialysis in end stage renal disease (ESRD) is associated with frequent cardiovascular modifications, mostly because of the highly fluctuating levels of potassium, magnesium, ionized calcium, sodium and volume status. The risk of arrhythmias is increased and chronic atrial fibrillation (AF) can be found among approximately 14% of patients. The renal disease combined with arrhythmias increases the risk of systemic thromboembolism but also of bleeding events. Here we present the case of a male patient, with ESRD, recently diagnosed with intradialytic paroxysmal AF for which oral anticoagulation therapy is initiated, but it’s early complicated with hemorrhagic pleural-pericarditis.
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Affiliation(s)
- Raluca-Mihaela Leonte
- Department of Cardiology, "Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Diseases, Iasi, Romania
| | - Laurențiu Vladimir Lucaci
- Department of Cardiology, "Prof. Dr. George I.M. Georgescu" Institute of Cardiovascular Diseases, Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Cristiana Elena Vlad
- Department of Internal Medicine, "Dr. C.I. Parhon", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Andreea Florea
- "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Laura Florea
- Department of Internal Medicine, "Dr. C.I. Parhon", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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24
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Whiting A, Reyes JVM, Ahmad S, Sayegh MN, Almas T, Song D. Thymic cancer: A not-so-indolent cause of pericardial effusion. Ann Med Surg (Lond) 2021; 71:102866. [PMID: 34659744 PMCID: PMC8503851 DOI: 10.1016/j.amsu.2021.102866] [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: 08/22/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 10/31/2022] Open
Abstract
The incidence of pericardial effusion in the U.S. is roughly 3.4% [1]. While most causes of pericardial effusions are indolent and transient, malignancy is a much more insidious cause that cannot be overlooked. Most cases of documented pericardial effusion secondary to malignancy have been due to mass effect from benign thymic tumors, such as thymomas. Our case highlights a 41-year-old male who presented with a dry cough and epigastric pain, found to have a large pericardial effusion and incidental thymic mass. The mass was biopsied and found to be keratinizing squamous cell carcinoma. This case expands our knowledge base as clinicians that pericardial effusions can be caused by malignant extension of tumors, rather than simply by mass effect of benign tumors.
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Affiliation(s)
- Adrian Whiting
- NYU Langone Hospital - Long Island, Department of Medicine, Mineola, NY, USA
| | - Jonathan Vincent M Reyes
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Department of Medicine, Elmhurst, NY, USA
| | - Saad Ahmad
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Department of Medicine, Elmhurst, NY, USA
| | - Mark N Sayegh
- St. John's Riverside Hospital, Department of Medicine, Yonkers, NY, USA
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Song
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Department of Medicine, Elmhurst, NY, USA
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25
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Melo MDTD, Paiva MG, Santos MVC, Rochitte CE, Moreira VDM, Saleh MH, Brandão SCS, Gallafrio CC, Goldwasser D, Gripp EDA, Piveta RB, Silva TO, Santo THCE, Ferreira WP, Salemi VMC, Cauduro SA, Barberato SH, Lopes HMC, Pena JLB, Rached HRS, Miglioranza MH, Pinheiro AC, Vrandecic BALM, Cruz CBBV, Nomura CH, Cerbino FME, Costa IBSDS, Coelho Filho OR, Carneiro ACDC, Burgos UMMC, Fernandes JL, Uellendahl M, Calado EB, Senra T, Assunção BL, Freire CMV, Martins CN, Sawamura KSS, Brito MM, Jardim MFS, Bernardes RJM, Diógenes TC, Vieira LDO, Mesquita CT, Lopes RW, Segundo Neto EMV, Rigo L, Marin VLS, Santos MJ, Grossman GB, Quagliato PC, Alcantara MLD, Teodoro JAR, Albricker ACL, Barros FS, Amaral SID, Porto CLL, Barros MVL, Santos SND, Cantisano AL, Petisco ACGP, Barbosa JEM, Veloso OCG, Spina S, Pignatelli R, Hajjar LA, Kalil Filho R, Lopes MACQ, Vieira MLC, Almeida ALC. Brazilian Position Statement on the Use Of Multimodality Imaging in Cardio-Oncology - 2021. Arq Bras Cardiol 2021; 117:845-909. [PMID: 34709307 PMCID: PMC8528353 DOI: 10.36660/abc.20200266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | - Mohamed Hassan Saleh
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Daniel Goldwasser
- Hospital Federal de Ipanema, Rio de Janeiro, RJ - Brasil
- Hospital Copa D'Or, Rio de Janeiro, RJ - Brasil
- Casa de Saúde São José, Rio de Janeiro, RJ - Brasil
| | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
| | | | - Tonnison Oliveira Silva
- Hospital Cardio Pulmonar - Centro de Estudos em Cardiologia, Salvador, BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
| | | | | | - Vera Maria Cury Salemi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Silvio Henrique Barberato
- CardioEco Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico, Curitiba, PR - Brasil
| | | | | | | | - Marcelo Haertel Miglioranza
- Instituto de Cardiologia do Rio Grande do Sul - Laboratório de Pesquisa e Inovação em Imagem Cardiovascular, Porto Alegre, RS - Brasil
- Hospital Mãe de Deus, Porto Alegre, RS - Brasil
| | | | | | | | - César Higa Nomura
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Fernanda Mello Erthal Cerbino
- Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ - Brasil
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Juliano Lara Fernandes
- Radiologia Clínica de Campinas, Campinas, SP - Brasil
- Instituto de Ensino e Pesquisa José Michel Kalaf, Campinas, SP - Brasil
| | - Marly Uellendahl
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Tiago Senra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Bruna Leal Assunção
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- ECOCENTER, Belo Horizonte, MG - Brasil
| | | | - Karen Saori Shiraishi Sawamura
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
- Instituto da Criança da Universidade de São Paulo (USP), São Paulo, SP - Brasil
| | - Márcio Miranda Brito
- Universidade Federal do Tocantins - Campus de Araguaina, Araguaina, TO - Brasil
- Hospital Municipal de Araguaina, Araguaina, TO - Brasil
| | | | | | | | | | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
- Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | - Letícia Rigo
- Hospital Beneficência Portuguesa, São Paulo, SP - Brasil
| | | | | | - Gabriel Blacher Grossman
- Clínica Cardionuclear, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Americas Serviços Médicos, Rio de Janeiro, RJ - Brasil
- Rede D'Or, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Simone Nascimento Dos Santos
- Hospital Brasília - Ecocardiografia, Brasília, DF - Brasil
- Eccos Diagnóstico Cardiovascular Avançado, Brasília, DF - Brasil
| | | | | | | | | | | | - Ricardo Pignatelli
- Texas Children's Hospital, Houston, Texas - EUA
- Baylor College of Medicine, Houston, Texas - EUA
| | - Ludhmilla Abrahão Hajjar
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Roberto Kalil Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Marcelo Antônio Cartaxo Queiroga Lopes
- Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, João Pessoa, PB - Brasil
- Hospital Metropolitano Dom José Maria Pires, João Pessoa, PB - Brasil
- Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - André Luiz Cerqueira Almeida
- Santa Casa de Misericórdia de Feira de Santana - Cardiologia, Feira de Santana, BA - Brasil
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia, São Paulo, SP - Brasil
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26
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Terry NLJ, Manapragada PP, Aziz MU, Singh SP. Review of pericardial disease on computed tomography. J Med Imaging Radiat Sci 2021; 52:S65-S77. [PMID: 34588141 DOI: 10.1016/j.jmir.2021.09.005] [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: 05/17/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Echocardiography has long been the mainstay in the evaluation of cardiac and pericardial disease. As computed tomography (CT) has advanced, it has become a valuable partner in the imaging of the pericardium. The advantages of CT include a larger field of view, multiplanar reconstruction and increased discrimination between various soft tissues and fluids. CT is less operator dependent and can more easily, and reproducibly, image areas of the pericardium for which echocardiography has poor windows such as the right pericardium. The introduction of EKG gating has decreased cardiac motion artifact and can allow functional evaluation although echocardiography remains the primary source of real-time imaging of cardiac and valve motion. It is essential for the skilled cardiac imager to understand the strengths and weaknesses of CT and its role in the definition and assessment of pericardial disease.
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Affiliation(s)
- Nina L J Terry
- University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, USA.
| | - Padma P Manapragada
- University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, USA
| | - Muhammad Usman Aziz
- University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, USA
| | - Satinder P Singh
- University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, USA
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27
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Russo D, Cinque A, Velardi L, Schino S, Perrone FNS, Beggio E, Romeo F, Gaspardone A. Giant pericardial mass case report: role of echocardiography. AME Case Rep 2021; 5:23. [PMID: 34312602 DOI: 10.21037/acr-20-141] [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: 09/22/2020] [Accepted: 03/07/2021] [Indexed: 11/06/2022]
Abstract
Cardiac masses are rare and they are distinguished in tumors and non-tumoral masses. Primary pericardial masses are very rare and they are often asymptomatic, even if they can present with sudden cardiac death. The diagnosis of these masses is often accidental and they are generally identified with echocardiography; their characterization is usually performed by cardiac magnetic resonance imaging (MRI) but the definitive diagnosis is achieved by tissue biopsy. We described a case of primary pericardial mass in an old patient with history of hypertension, which presented at our hospital with dyspnea and low-extremity edema. The echocardiography described a giant iso/hypoechoic pericardial mass that extended on anterior, posterior and lateral walls of left ventricle and atrium, associated with pericardial effusion without hemodynamic compromise. We discovered that the mass was identified twenty years ago on a chest-computed tomography (CT). Even if we do not manage in performing a cardiac MRI, from echo characteristics we supposed that the mass was a lipoma. Lipomas are benign tumors that can develop from pericardium and they have slow growth so they can be asymptomatic for several years. Their excision is important because they may be responsible for pericardial tamponade or heart failure. Echocardiography is an economic non-invasive exam and it is helpful in differential diagnosis, treatment, follow-up and prognosis of this cardiac masses.
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Affiliation(s)
- Debora Russo
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy.,Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | | | - Laura Velardi
- Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | - Sofia Schino
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy.,Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | - Fabrizio Nicolò Stefano Perrone
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy.,Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | - Elisa Beggio
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy.,Division of Cardiology, Sant' Eugenio Hospital, Rome, Italy
| | - Francesco Romeo
- Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy
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28
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Abstract
PURPOSE OF REVIEW Tumors of the pericardium are rare, but a wide variety of congenital, infectious, inflammatory, and neoplastic processes have been reported. Pericardial tumors can be categorized as non-neoplastic or neoplastic. Neoplastic lesions can be further divided into benign or malignant, with malignancies being either primary or secondary (metastatic). Clinical, radiographic, and pathologic features of the most common entities are discussed. RECENT FINDINGS Metastatic neoplasms involving the heart and pericardium are far more common than primary pericardial neoplasms. Of primary pericardial malignancies, mesothelioma is the most common; notably, cytology of effusion fluid is relatively insensitive to the diagnosis. The prognosis for most malignancies of the pericardium, primary or secondary, is poor. Increasingly, clinically recognized diseases that involve the pericardium include Erdheim-Chester and IgG4-related disease. This article provides a comprehensive review of the most recent literature to develop a structured framework to the differential diagnosis of pericardial tumors.
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29
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Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology. Biomedicines 2021; 9:biomedicines9070774. [PMID: 34356838 PMCID: PMC8301302 DOI: 10.3390/biomedicines9070774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Primary malignant cardiac tumors are rare, with a prevalence of about 0.01% among all cancer histotypes. At least 60% of them are primary soft tissue sarcomas of the heart (pSTS-h) that represent almost 1% of all STSs. The cardiac site of origin is the best way to classify pSTS-h as it is directly linked to the surgical approach for cancer removal. Indeed, histological differentiation should integrate the classification to provide insights into prognosis and survival expectancy of the patients. The prognosis of pSTS-h is severe and mostly influenced by the primary localization of the tumor, the difficulty in achieving complete surgical and pharmacological eradication, and the aggressive biological features of malignant cells. This review aims to provide a detailed literature overview of the most relevant issues on primary soft tissue sarcoma of the heart and highlight potential diagnostic and therapeutic future perspectives.
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30
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Xu SM, Bai J, Cai JH. Primary primitive neuroectodermal tumor in the pericardium—a focus on imaging findings: A case report. World J Clin Cases 2021; 9:4336-4341. [PMID: 34141798 PMCID: PMC8173412 DOI: 10.12998/wjcc.v9.i17.4336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/19/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primitive neuroectodermal tumors (PNETs) are rare, sporadic malignant tumors of the peripheral nervous system, bone, or soft tissues. However, to the best of our knowledge, only three cases of PNET in the pericardium have been reported in the English literature, and their magnetic resonance imaging findings have not previously been described.
CASE SUMMARY A 3-year-old boy was hospitalized with a 1-wk history of recurrent vomiting and weakness. Detailed history-taking revealed no evidence of heart disease. Computed tomography demonstrated a soft tissue mass in the left pericardial cavity with heterogeneous contrast enhancement. The border between the mass and the heart was poorly defined. Thoracotomy revealed a mass invading the left ventricle, with a high risk of bleeding. The mass was considered inoperable. A biopsy was performed, and the histological and immunohistochemical findings confirmed the diagnosis of primary PNET of the pericardium. The patient received four cycles of standard chemotherapy. Chest magnetic resonance imaging 3 mo after the initiation of chemotherapy revealed that the tumor in the pericardium still existed, but its volume had slightly decreased. The patient was lost to follow-up, and the final outcome was therefore unknown.
CONCLUSION Medical imaging plays an important role in defining the pericardial origin of PNET and understanding its characteristics. Magnetic resonance imaging can provide more information on the tumor than computed tomography and may thus aid therapeutic planning.
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Affiliation(s)
- Shu-Ming Xu
- Department of Radiology, Children’s Hospital of Shanxi, Taiyuan 030013, Shanxi Province, China
| | - Juan Bai
- Department of Medical Imaging, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Jin-Hua Cai
- Department of Radiology, Children’s Hospital, Chongqing Medical University, Chongqing 400014, China
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31
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Multiple pericardial hematomas: a case report and mini-review in multimodality imaging. BMC Med Imaging 2021; 21:85. [PMID: 34006236 PMCID: PMC8130273 DOI: 10.1186/s12880-021-00617-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pericardial hematoma is blood accumulation in the pericardial space. Although rare, it could arise in various conditions, such as after cardiac surgery. Clinical diagnosis of pericardial hematoma is implausible; thus, cardiac imaging plays a pivotal role in identifying this condition. We presented a case of multiple pericardial hematomas, which was found as an incidental finding in post-cardiac surgery evaluation. We highlighted the diagnostic challenge and the key features of multi-modality cardiac imaging in pericardial hematoma evaluation. CASE PRESENTATION An asymptomatic, 35-years old male, who underwent surgical closure of secundum atrial septal defect (ASD) one month ago, came for routine transthoracic echocardiography evaluation. An intrapericardiac hematoma was visualized at the right ventricle (RV) 's free wall side. Another mass with an indistinct border was visualized near the right atrium (RA). This mass was suspected as pericardial hematoma differential diagnosed with intracardiac thrombus. Cardiac computed tomography (CT) scan showed both masses have an attenuation of 30-40 HU; however, the mass's border at the RA side was still not clearly delineated. Mild superior vena cava (SVC) compression and multiple mediastinal lymphadenopathies were also detected. These findings are not typical for pericardial hematomas nor intracardiac thrombus; hence another additional differential diagnosis of pericardial neoplasm was considered. We pursued further cardiac imaging modalities because the patient refused to undergo an open biopsy. Single-photon emission computer tomography (SPECT)/CT with Technetium-99 m (Tc-99 m) macro-aggregated albumin (MAA) and Sestamibi showed filling defect without increased radioactivity, thus exclude the intracardiac thrombus. Cardiac magnetic resonance imaging (MRI) reveals intrapericardial masses with low intensity of T1 signal and heterogeneously high intensity on T2 signal weighted imaged and no evidence of gadolinium enhancement, which concluded the diagnosis as subacute pericardial hematomas. During follow-up, the patient remains asymptomatic, and after six months, the pericardial hematomas were resolved. CONCLUSION Pericardial hematoma should be considered as a cause of pericardial masses after cardiac surgery. When imaging findings are atypical, further multi-modality cardiac imaging must be pursued to establish the diagnosis. Careful and meticulous follow-up should be considered for an asymptomatic patient with stable hemodynamic.
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32
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Chapra AF, Maliyakkal AM, Naushad VA, Valiyakath HS, Ahmed MS. Primary Pericardial Synovial Sarcoma: An Extremely Rare Cardiac Neoplasm. Cureus 2021; 13:e14583. [PMID: 34036003 PMCID: PMC8136297 DOI: 10.7759/cureus.14583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Primary pericardial tumors are an entity that is infrequently encountered and may be a cause of pericardial effusion. Primary synovial sarcomas of the pericardium are even rarer malignant invasive tumors that are a challenge to recognize due to their vague presentation and difficulty in diagnosing non-invasively. Here, we report a case of a 48-year-old gentleman of South Asian descent, who was incidentally found to have pericardial and bilateral pleural effusions and subsequently diagnosed to have primary pericardial synovial sarcoma.
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Affiliation(s)
| | | | - Vamanjore A Naushad
- General Internal Medicine, Hamad Medical Corporation, Doha, QAT.,Clinical Medicine, Weill Cornell, Doha, QAT.,Clinical Medicine, College of Medicine Qatar University, Doha, QAT
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33
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Shu S, Yuan H, Kong X, Wang J, Wang J, Zheng C. The value of multimodality imaging in diagnosis and treatment of cardiac lipoma. BMC Med Imaging 2021; 21:71. [PMID: 33858367 PMCID: PMC8048252 DOI: 10.1186/s12880-021-00603-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Background Cardiac lipoma is a rare primary tumor in the heart and pericardium. Multimodality imaging methods, especially magnetic resonance imaging (MRI), are crucial in detecting and diagnosing cardiac lipomas. Besides, they are of significant importance in management of cardiac lipomas. The aim of this study was to evaluate the value of multimodality imaging methods in diagnosing and treatment of cardiac lipoma by describing a series of cases of cardiac lipoma. Materials and methods Data of patients with cardiac lipoma at a local institution were retrospectively collected. Their imaging findings on echocardiography, computed tomography (CT), and cardiac MRI and clinical management were described in detail. Results 12 patients with cardiac lipoma were retrospectively included with thirteen lipomas found within heart and pericardium. Two patients’ lipoma were symptomatic, while lipomas in other 10 patients were found incidentally. Most lipomas were sensitively detected with echocardiography. Accurate diagnoses were achieved with CT and MRI in all cases. Surgical resection was performed in one symptomatic patient due to the obstruction of the left ventricular outflow tract, while the removal of pericardial lipoma in another symptomatic patient was not possible due to diffuse myocardial infiltration observed in MRI. Based on MRI findings, two patients without clinical symptoms also underwent surgery to prevent the risk of detachment of ventricular lipoma with a narrow pedicle in one patient and potential further thinning of the myocardium by pericardial lipoma growth in another patient. Conclusions Cardiac lipoma could be sensitively detected and accurately diagnosed with multiple noninvasive imaging tools. Comprehensive evaluation with multimodality imaging methods should also be conducted for better management planning and follow-up in all patients.
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Affiliation(s)
- Shenglei Shu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Hongliang Yuan
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jiazheng Wang
- Clinical and Technical Solutions, Philips Healthcare, Beijing, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Ave, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
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Mirmomen SM, Matthew TL, Arai AE, Sirajuddin A. Pericardial Perivascular Epithelioid Cell Neoplasm. Radiol Cardiothorac Imaging 2021; 3:e200532. [PMID: 33969310 DOI: 10.1148/ryct.2021200532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
Supplemental material is available for this article.
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Affiliation(s)
- S Mojdeh Mirmomen
- National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (S.M.M., A.E.A., A.S.); and Department of Cardiac Surgery, Suburban Hospital, Bethesda, Md (T.L.M.)
| | - Thomas L Matthew
- National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (S.M.M., A.E.A., A.S.); and Department of Cardiac Surgery, Suburban Hospital, Bethesda, Md (T.L.M.)
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (S.M.M., A.E.A., A.S.); and Department of Cardiac Surgery, Suburban Hospital, Bethesda, Md (T.L.M.)
| | - Arlene Sirajuddin
- National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (S.M.M., A.E.A., A.S.); and Department of Cardiac Surgery, Suburban Hospital, Bethesda, Md (T.L.M.)
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35
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Mechanisms and clinical manifestations of cardiovascular toxicities associated with immune checkpoint inhibitors. Clin Sci (Lond) 2021; 135:703-724. [PMID: 33686402 DOI: 10.1042/cs20200331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022]
Abstract
Immunotherapies have greatly expanded the armamentarium of cancer-directed therapies in the past decade, allowing the immune system to recognize and fight cancer. Immune checkpoint inhibitors (ICIs), in particular, have revolutionized cancer treatment and have demonstrated survival benefit in numerous types of cancer. These monoclonal antibodies increase anti-cancer immunity by blocking down-regulators of adaptive immunity, including cytotoxic T lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), and its ligand (PD-L1), resulting in anti-tumor activity. As ICIs increase immune system activation, they can cause a wide range of inflammatory side effects, termed immune-released adverse events. Though these toxicities can affect nearly any organ, the most fatal toxicity is myocarditis. Here, we discuss the diverse spectrum of cardiovascular toxicities associated with ICI use. In addition, we provide insight and future directions on mechanisms and treatments for immune-related adverse events (irAEs) involving the myocardium, pericardium, vasculature, and conduction system.
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Utrera-Costero A, Prado-Wohlwend S, Vera-Pinto VJ, Bello-Arqués P, Agudelo-Cifuentes M, Bernal-Vergara JC. Pericardial synovial tumor, a rare entity to diagnose by imaging. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remnie.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Shu S, Wang J, Zheng C. From pathogenesis to treatment, a systemic review of cardiac lipoma. J Cardiothorac Surg 2021; 16:1. [PMID: 33407682 PMCID: PMC7788760 DOI: 10.1186/s13019-020-01379-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023] Open
Abstract
Cardiac lipoma is an uncommon primary cardiac tumor. With the advancement of diagnostic methods and treatment techniques, more cases of cardiac lipomas have been reported and suggest that the entity previously widely thought to display classic features may also show atypical findings. A systemic review of the rare cardiac tumor was done by searching the literature of cardiac lipoma. We endeavor to summarize the clinical features of the rare disease from pathogenesis to treatment. Literature of cardiac lipoma was retrospectively searched through PubMed and 255 cases of cardiac lipoma were included into this analysis. Cardiac lipomas can occur anywhere within the heart, 53.1% were located within the cardiac chambers, 32.5% in the pericardium, 10,7% within the myocardium and 3.7% involved multiple structures. More than half of the reported cardiac lipomas (66%) may be clinically symptomatic, presenting with symptoms ranging from chest discomfort to syncope depending on their size and location as well as extent of myocardial involvement. Noninvasive cardiac imaging has replaced the role of autopsy and cardiothoracic surgery in detection and diagnosis of cardiac lipomas. Most symptomatic patients (83.7%) were treated by resection of cardiac lipomas and 68.3% of asymptomatic patients also underwentprophylactic resection. Overgrowth and myocardial infiltration of lipomas may result in unsuccessful resection. Recurrence of cardiac lipomas was rare but reported in a few cases. The early detection and accurate diagnosis of cardiac lipoma is of great significance in clinical management, to avoid an unfavourable outcome due to overgrowth.
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Affiliation(s)
- Shenglei Shu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Techonolgy, No.1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Techonolgy, No.1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuangsheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Techonolgy, No.1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
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38
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Alex A, Ayyappan A, Valakkada J, Pillai VV, Sreekantan R, Poyuran R. Pericardial pseudocyst along atrioventricular groove. BJR Case Rep 2020; 7:20200122. [PMID: 33841901 PMCID: PMC8008468 DOI: 10.1259/bjrcr.20200122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/22/2022] Open
Abstract
Cystic lesions in relation to the pericardium are a rare congenital lesion with an estimated incidence of 1 per 100,,000. Pericardial cysts may be classified as congenital or acquired. Here, we present a case of a pericardial pseudocyst having a horseshoe configuration along the atrioventricular groove in a middle-aged subject with no previous relevant medical history. The patient underwent open surgery for the same with histopathological diagnosis being established. This paper highlights the differentials for a cystic pericardial lesion in imaging in addition to the histopathological entity of a pericardial pseudocyst.
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Affiliation(s)
- Ajay Alex
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Anoop Ayyappan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Vivek V Pillai
- Department of Cardiovascular & Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Renjith Sreekantan
- Department of Cardiovascular & Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Rajalakshmi Poyuran
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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39
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Utrera-Costero A, Prado-Wohlwend S, Vera-Pinto VJ, Bello-Arqués P, Agudelo-Cifuentes M, Bernal-Vergara JC. Pericardial synovial tumor, a rare entity to diagnose by imaging. Rev Esp Med Nucl Imagen Mol 2020; 40:115-116. [PMID: 33309215 DOI: 10.1016/j.remn.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 10/22/2022]
Affiliation(s)
- A Utrera-Costero
- Servicio de Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - S Prado-Wohlwend
- Servicio de Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - V J Vera-Pinto
- Servicio de Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - P Bello-Arqués
- Servicio de Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M Agudelo-Cifuentes
- Servicio de Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J C Bernal-Vergara
- Servicio de Medicina Nuclear, Hospital Universitario y Politécnico La Fe, Valencia, España
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40
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Behram M, Oğlak SC, Acar Z, Sezer S, Bornaun H, Çorbacıoğlu A, Özdemir İ. Fetal cardiac tumors: prenatal diagnosis, management and prognosis in 18 cases. J Turk Ger Gynecol Assoc 2020; 21:255-259. [PMID: 33274615 PMCID: PMC7726467 DOI: 10.4274/jtgga.galenos.2020.2019.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate the long-term follow-up of patients with fetal cardiac tumors (FCTs), and to review the literature regarding advances in diagnosis and management of FCTs in the last decade. Material and Methods: In this retrospective study, pregnant women referred to a single center maternal-fetal medicine unit between 2013 and 2018 for advanced ultrasonography, were reviewed. Pediatric cardiology counseling was offered to women whose fetuses had FCTs. All patients were evaluated according to revised diagnostic criteria for tuberous sclerosis complex (TSC). Medical treatment was administered to patients with FCTs ≥30 mm or if they were symptomatic. Everolimus therapy at a dose of 2x0.25 mg twice a week for three months was started in the postnatal period. Results: Out of the 75,312 patients referred 18 (0.024%) were diagnosed with FCTs. Six were referred with fetal arrhythmias and the others were diagnosed with FCTs during routine follow-up. Ten patients (55%) with FCTs were diagnosed with TSC. All tumors were assessed to be rhabdomyoma. Mean tumor diameter in fetuses with TSC was significantly larger than those without TSC (29.8±14.1 mm versus 9.3±4.8 mm, respectively; p=0.004). All patients (n=2) who received medical therapy had a diagnosis of TSC and multiple FCTs and a reduction in tumor size occurred. Tumor size decreased in eight patients spontaneously during follow-up, but increased in one patient who had multiple locations but no TCS. No change in size was observed in the remaining seven cases. None of the fetuses died during the 1-5 year follow-up period. Conclusion: Rhabdomyoma are usually multiple and associated with TSC. Rhabdomyomas with TSC are larger, but most regress spontaneously or respond well to medical treatment after birth, and have an excellent long-term prognosis.
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Affiliation(s)
- Mustafa Behram
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Cemil Oğlak
- Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Züat Acar
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Salim Sezer
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Helen Bornaun
- Clinic of Pediatric Cardiology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Aytül Çorbacıoğlu
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - İsmail Özdemir
- Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
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41
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Ho N, Nesbitt G, Hanneman K, Thavendiranathan P. Assessment of Pericardial Disease with Cardiovascular MRI. Heart Fail Clin 2020; 17:109-120. [PMID: 33220880 DOI: 10.1016/j.hfc.2020.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Disorders of the pericardium are common and can result in significant morbidity and mortality. Advances in multimodality imaging have enhanced our ability to diagnose and stage pericardial disease and improve our understanding of the pathophysiology of the disease. Cardiovascular MRI (CMR) can be used to define pericardial anatomy, identify the presence and extent of active pericardial inflammation, and assess the hemodynamic consequences of pericardial disease. In this way, CMR can guide the judicial use of antiinflammatory and immune modulatory medications and help with timing of pericardiectomy. CMR can also be used to diagnose congenital disorders of the pericardium. Furthermore, CMR can be used to define pericardial masses and understand their malignant potential.
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Affiliation(s)
- Natalie Ho
- Division of Cardiology, Scarborough Health Network, Scarborough General Hospital, 3050 Lawrence Avenue, Toronto, Ontario M1P 2V5, Canada
| | - Gillian Nesbitt
- Division of Cardiology, Mount Sinai Hospital, Suite 1609, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, Toronto General Hospital, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology and Radiology, Toronto General Hospital, 4N-490, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada.
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42
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Glybochko PV, Fomin VV, Chichkova NV, Kogan EA, Svistunov AA, Komarov RN, Syrkin AL. Primary Undifferentiated Pericardial Sarcoma after Radiоtherapy for Hodgkin Lymphoma. Case Rep Oncol 2020; 13:1075-1081. [PMID: 33082751 PMCID: PMC7548883 DOI: 10.1159/000510068] [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: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022] Open
Abstract
Various types of sarcomas arise as a result of postradiation chronic fibrous pericarditis. A primary undifferentiated spindle cell pericardial sarcoma is a rare type of sarcoma after radiotherapy. The risk of sarcoma increases with time after treatment of cancer. A 55-year-old woman underwent successful radiation and chemotherapy for Hodgkin lymphoma 20 years ago. She was hospitalized with typical manifestations of severe heart failure. Echocardiography, сomputed tomography of the chest and magnetic resonance imaging scan of the heart detected neoplastic formations of the pericardium. A biopsy of the pericardium was performed. Histological, immunohistochemical, and genetic studies showed a primary undifferentiated spindle cell pericardial sarcoma (an extremely rare type of sarcoma).
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Affiliation(s)
- Petr V Glybochko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Victor V Fomin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Natalia V Chichkova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Evgeniya A Kogan
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Andrei A Svistunov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Roman N Komarov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Abram L Syrkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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43
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Role of cardiovascular magnetic resonance in an adolescent with a giant intrapericardial mass. Cardiol Young 2020; 30:1524-1526. [PMID: 32778186 DOI: 10.1017/s1047951120002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 14 -year-old boy presented with chest pain and breathlessness. Echocardiography showed a large pericardial effusion with cardiac tamponade features and suspicion of cardiac mass. Cardiovascular magnetic resonance demonstrated a large, well-defined pericardial mass, suggesting atypical large coronary fistula with pericardial haematoma or primary cardiac/pericardial tumour such as angiosarcoma. Histology confirmed a mixed-type vascular malformation. Sirolimus therapy was initiated.
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44
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Dudgeon MG, Sonavane SK, Parent EE, Khoor A, Thomas M. Co-existent Epicardial Paraganglioma and Anterior Mediastinal Thymoma. J Radiol Case Rep 2020; 14:16-30. [PMID: 33708339 PMCID: PMC7942970 DOI: 10.3941/jrcr.v14i10.4101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thymoma and paraganglioma are known causes of mediastinal masses, the latter being extremely rare. Thymomas arise from remnant thymic tissue in the anterior mediastinum; whereas, thoracic paragangliomas arise from para-aortic or para-vertebral sympathetic chain ganglion (derivatives of embryonic neural crest) in the middle or posterior mediastinum. We report a case of a middle-aged woman with two mediastinal masses, originally believed to be a single tumor or primary malignancy with adjacent metastasis on Computed Tomography (CT) that were further delineated with Magnetic Resonance Imaging (MRI) and [68Ga]-DOTA-(Tyr3)-octreotate (DOTA-TATE) Positron Emission Tomography-Computed Tomography (PET-CT) and surgical pathology as two distinct entities: left epicardial paraganglioma and anterior mediastinal thymoma. A comprehensive discussion of both entities is included.
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Affiliation(s)
| | - Sushilkumar K Sonavane
- Department of Radiology, Division of Cardiothoracic Imaging, Mayo Clinic, Jacksonville, FL, USA
| | - Ephraim E Parent
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Andras Khoor
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Mathew Thomas
- Department of Cardiovascular/Thoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
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45
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Abstract
PURPOSE OF REVIEW Cardiovascular magnetic resonance (CMR) provides the most comprehensive imaging assessment of pericardial disease, providing a three-dimensional assessment of the pericardium, functional assessment of its impact on cardiac contractility, and pericardial tissue/fluid characterization. This review presents an update on the utility of CMR imaging in a wide variety of pericardial diseases. RECENT FINDINGS CMR provides both qualitative and quantitative assessment of the pericardium through various imaging techniques. It can also be used as a guide therapy and delineate response to treatment in pericarditis. CMR is also useful for the assessment of rare congenital disorders and in defining pericardial tumors and differentiating some non-invasively. CMR is a powerful non-invasive diagnostic tool for evaluating and characterizing pericardial diseases. Ongoing optimization of imaging techniques allows for differentiation of subtypes of disease as well as progression. Ongoing research demonstrates continued expanding role of CMR in both the diagnosis and management of pericardial and cardiovascular disease.
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46
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Avondo S, Andreis A, Casula M, Imazio M. Update on diagnosis and management of neoplastic pericardial disease. Expert Rev Cardiovasc Ther 2020; 18:615-623. [PMID: 32797759 DOI: 10.1080/14779072.2020.1811087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pericardial neoplasms are uncommon, mostly due to secondary involvement of the pericardium by extracardiac tumors. Clinical presentation is nonspecific, frequently leading to a delayed diagnosis. Moreover, both benign and malignant pericardial tumors may be associated with myocardial infiltration and mechanical compression of cardiac chambers, possibly precipitating clinical conditions. Pericardial tumors are indeed a diagnostic and therapeutic clinical challenge. AREAS COVERED This review aims to provide an overview of the main clinical characteristics of pericardial tumors, along with their management in clinical practice. EXPERT COMMENTARY Multimodality imaging (echocardiography, chest X-ray, CT, CMR, and PET) enable full characterization of pericardial neoplasms. An individualized strategy should be developed by a multidisciplinary team including cardiologists, oncologists, radiologists, and cardiac surgeons.
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Affiliation(s)
- Stefano Avondo
- Cardiovascular and Thoracic Department, University Cardiology, AOU Città Della Salute e Della Scienza Di Torino , Torino, Italy
| | - Alessandro Andreis
- Cardiovascular and Thoracic Department, University Cardiology, AOU Città Della Salute e Della Scienza Di Torino , Torino, Italy
| | - Matteo Casula
- Cardiovascular and Thoracic Department, University Cardiology, AOU Città Della Salute e Della Scienza Di Torino , Torino, Italy
| | - Massimo Imazio
- Cardiovascular and Thoracic Department, University Cardiology, AOU Città Della Salute e Della Scienza Di Torino , Torino, Italy
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47
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Khurana R, Sharma S, Kumar S, Deshpande AA, Wadhwa D, Agasty S. Paraneoplastic pemphigus associated with a pericardial ectopic thymoma. J Card Surg 2020; 35:3141-3144. [PMID: 32840923 DOI: 10.1111/jocs.14955] [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] [Received: 06/21/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022]
Abstract
Paraneoplastic Pemphigus (PNP), a rare autoimmune blistering disease, can be accompanied by both benign and malignant neoplasms. The most frequently reported associated malignancies include lymphomatoid and hematologic malignancies, Castleman's disease, carcinoma, thymoma. In a patient suspected of PNP, with no known history of malignancy, an extensive workup is suggested to look for underlying malignancy, which has to be treated to induce PNP remission. In this clinical case report, cross sectional imaging of a young female diagnosed with PNP, unveiled a pericardial mass lesion extending into transverse pericardial sinus. Excisional biopsy was performed. Histopathology revealed pericardial ectopic thymoma.
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Affiliation(s)
- Rishabh Khurana
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Ajit Deshpande
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Dhaarna Wadhwa
- Department of Dermatology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sumit Agasty
- Department of Cardio-Thoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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48
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Burt JR, Limback J, Molina M, Suarez J, Mekhail T, Fanaian N, Aquino G, Kabakus I, Weyant A, Scherer K. Fat-Finding Mission: Primary Pleomorphic Liposarcoma of the Heart and Pericardium. JACC Case Rep 2020; 2:1520-1526. [PMID: 34317009 PMCID: PMC8302169 DOI: 10.1016/j.jaccas.2020.05.099] [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: 12/09/2019] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Abstract
Primary cardiac liposarcomas are rare tumors with a poor prognosis and no well-defined imaging characteristics or treatment guidelines. Here, we present a case of primary pleomorphic liposarcoma of the heart and pericardium with multimodality imaging findings and our institution’s treatment approach. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Jeremy R Burt
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph Limback
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Melanie Molina
- College of Medicine, University of Central Florida, Orlando, Florida
| | - Jorge Suarez
- Departments of Surgery, Internal Medicine, Radiology, and Pathology, Advent Health Orlando, Orlando, Florida
| | - Tarek Mekhail
- Departments of Surgery, Internal Medicine, Radiology, and Pathology, Advent Health Orlando, Orlando, Florida
| | - Naim Fanaian
- Departments of Surgery, Internal Medicine, Radiology, and Pathology, Advent Health Orlando, Orlando, Florida
| | - Gilberto Aquino
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Ismail Kabakus
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Austin Weyant
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Kurt Scherer
- Departments of Surgery, Internal Medicine, Radiology, and Pathology, Advent Health Orlando, Orlando, Florida
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49
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Tyebally S, Chen D, Bhattacharyya S, Mughrabi A, Hussain Z, Manisty C, Westwood M, Ghosh AK, Guha A. Cardiac Tumors: JACC CardioOncology State-of-the-Art Review. JACC: CARDIOONCOLOGY 2020; 2:293-311. [PMID: 34396236 PMCID: PMC8352246 DOI: 10.1016/j.jaccao.2020.05.009] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl’s excrescences, and pericardial cyst). The advent of multimodality imaging has enabled identification of the etiology of cardiac masses in many cases, especially in conjunction with information from clinical settings. This paper provides a comprehensive review of the epidemiology, clinical presentation, imaging, diagnosis, management, and outcomes of cardiac masses. Cardiac tumors are rare and should be considered as part of the differential diagnosis of any space-occupying mass noted on cardiovascular and/or thoracic imaging modalities. It may be possible to get close to a diagnosis without biopsy using a structured imaging approach. The prognosis and treatment of each tumor is different, although early diagnosis is usually associated with a better outcome.
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Affiliation(s)
- Sara Tyebally
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Daniel Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Sanjeev Bhattacharyya
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Abdallah Mughrabi
- Jordan University of Science and Technology, Al Ramtha, Irbid, Jordan
| | - Zeeshan Hussain
- Division of Cardiology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Charlotte Manisty
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Mark Westwood
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Cardio-Oncology Service, University College London Hospital, London, United Kingdom
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
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Alomari L, Khushaim A. Diagnosis of Epipericardial Fat Necrosis on multimodality imaging in a pediatric patient: a case report and review of the literature. J Radiol Case Rep 2020; 14:16-24. [PMID: 33082923 DOI: 10.3941/jrcr.v14i5.3971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This is a case report of a 13-year-old male, presented to the Emergency Department complaining of a sudden onset left-sided pleuritic chest pain for 1 day. He was found to have a mass in the left Epipericardial fat with fat stranding and pleural effusion supporting the diagnosis of Epipericardial Fat Necrosis. The findings were established by Computed tomography and Ultrasound, and the final diagnosis was confirmed by Magnetic resonance imaging. Subsequently, the patient was discharged on analgesia; reassessment one-month later showed clinical improvement with no symptom recurrence. Repeated Ultrasound demonstrated a marked decrease in size and echogenicity of the mass. In this paper we review the clinical and radiological manifestations of Epipericardial fat necrosis and the different management approaches taken over the years.
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Affiliation(s)
- Lama Alomari
- Department of Emergency Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ayman Khushaim
- Department of Radiology, McGill University Health Center, Montreal, Canada
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