1
|
Chang L, Gong C, Lu H, Liu Y, Kang L, Chen J, Wang L, Xu B. Percutaneous intravenous catheter forceps biopsy in right atrial mass: two case reports and literature review. BMC Cardiovasc Disord 2022; 22:63. [PMID: 35184743 PMCID: PMC8859873 DOI: 10.1186/s12872-022-02507-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/10/2022] [Indexed: 12/17/2022] Open
Abstract
Background Primary malignant tumors of the heart are rare. Although preoperative histological diagnosis is difficult, it has paramount value in therapeutic strategy development and prognostic estimation. Herein, we reported 2 cases of intracardiac tumors. Cases presentation Both patients presented to the hospital with heart-related symptoms. Echocardiography showed massive masses in the atrium and positron emission tomography–computed tomography (PET/CT) revealed hypermetabolism and invasiveness. One patient cannot take surgery due to extensive metastasis and poor condition. The other patient was primarily diagnosed with lymphoma, and surgery was not recommended. They successfully underwent intravenous atrial biopsy, and histological samples confirmed intimal sarcoma and diffuse large B cell lymphoma. Based on immunohistochemical and molecular assessments, targeted chemotherapy was administered, resulting in clinical and imaging remission at discharge. Conclusions Percutaneous intravenous catheter biopsy as a safe invasive test provides an accurate pathological diagnosis after imaging evaluation, and offers a therapeutic direction. Nonmalignant masses and some chemo-radiosensitive malignant tumors in the atrium could have good prognosis after targeted therapy.
Collapse
|
2
|
Amari K, Tago M, Katsuki NE, Fukumori N, Yamashita SI. Cardiac Recurrence of Diffuse Large B-cell Lymphoma More Than a Decade After Attaining Complete Remission. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1057-1062. [PMID: 30177676 PMCID: PMC6135044 DOI: 10.12659/ajcr.910787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patient: Female, 79 Final Diagnosis: Cardiac recurrence of DLBCL Symptoms: Cardiogenic shock Medication: — Clinical Procedure: Biopsy specimen Specialty: Cardiology/Hematology
Collapse
Affiliation(s)
- Kaori Amari
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan.,Department of Emergency Medicine, Saga-Ken Medical Centre, Koseikan, Saga City, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| | - Norio Fukumori
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga City, Saga, Japan
| | - Shu-Ichi Yamashita
- Department of General Medicine, Saga University Hospital, Saga City, Saga, Japan
| |
Collapse
|
3
|
Weinberg L, Abu-Ssaydeh D, Macgregor C, Wang J, Wong C, Spanger M, Muralidharan V. Transjugular biopsy case report of inferior vena cava hepatocellular carcinoma with intracardiac extension. Int J Surg Case Rep 2017; 39:324-327. [PMID: 28898796 PMCID: PMC5597876 DOI: 10.1016/j.ijscr.2017.08.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Diagnosis of hepatocellular carcinoma (HCC) can be established with near certainty by correlating radiological imaging with clinical presentation. However, in the absence of diagnostic certainty, biopsy of liver tissue is mandatory for optimal management. We present our management of a patient with advanced liver disease who presented with an IVC mass extending into the right atrium, with co-existing liver lesions not meeting criteria for an imaging diagnosis of HCC. CASE PRESENTATION A 62-year-old male with Child-Pugh C liver cirrhosis presented with decompensated liver failure. Multiple imaging modalities demonstrated an inferior vena cava (IVC) mass extending into the right atrium with co-existing liver lesions not meeting radiological criteria for an imaging diagnosis of HCC. There was no contiguous evidence of HCC in the liver, yet there was extensive tumour burden in the IVC representing a separate metastatic lesion without any indication of direct tumour spread. Under fluoroscopic and angiographic guidance, a biopsy catheter was advanced through the right atrium into the IVC. Histology from the biopsy demonstrated fragments of malignant tumour with features consistent with moderately differentiated HCC without thrombus. Given the poor prognosis associated with metastatic HCC with IVC and intracardiac involvement, a multidisciplinary decision was made with the patient's family for palliation care. CONCLUSION Transjugular biopsy of IVC masses can be performed effectively, in an awake patient, without the need for sedation or anaesthesia. Where multiple imaging modalities fail to confirm a diagnosis for liver or IVC pathology, transluminal biopsy can assist with definitive diagnosis and treatment planning.
Collapse
Affiliation(s)
- Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia; Department of Surgery, University of Melbourne, Austin Health, 8002, Victoria, Australia.
| | - Diana Abu-Ssaydeh
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
| | - Chris Macgregor
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
| | - Jason Wang
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
| | - Clarence Wong
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
| | - Manfred Spanger
- Department of Radiology, Box Hill Hospital, Box Hill, Victoria, 3128, Australia.
| | | |
Collapse
|
4
|
George JC, Varghese V, Mogtader A. Intracardiac echocardiography: evolving use in interventional cardiology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:387-395. [PMID: 24567449 DOI: 10.7863/ultra.33.3.387] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intracardiac echocardiography (ICE) uses a catheter-based steerable ultrasound probe that is passed into the right heart chambers to image intracardiac structures. The transducer can be variably positioned for optimal imaging: in the inferior vena cava to visualize the abdominal aorta; in the right atrium for the interatrial septum, aortic, mitral, and tricuspid valves, and pulmonary veins; or in the right ventricle for the left ventricular function, outflow tract, or pulmonary artery. Intracardiac echocardiography is primarily used for imaging during an invasive cardiac procedure using conscious sedation, when transthoracic image quality would likely be inadequate, and transesophageal imaging would require general anesthesia. Intracardiac echocardiography is generally well tolerated and provides adequate images and sufficient information for the procedure performed. In the cardiac catheterization laboratory, ICE is routinely used for patent foramen ovale, atrial septal defect, and ventricular septal defect closures, allowing adequate percutaneous placement of septal occluders. It is now being considered in the current era of transcatheter aortic valve implantation necessitating improved imaging approaches for accurate placement. It is also routinely used for trans-septal punctures during mitral valvuloplasty and, more recently, with the advent of left atrial appendage closure devices. This article provides a comprehensive review of the current technology for ICE and its growing applications in the realm of interventional cardiology.
Collapse
Affiliation(s)
- Jon C George
- Cardiac Catheterization Laboratory, Deborah Heart and Lung Center, 200 Trenton Rd, Browns Mills, NJ 08015 USA.
| | | | | |
Collapse
|
5
|
Ali S, George LK, Das P, Koshy SKG. Intracardiac echocardiography: clinical utility and application. Echocardiography 2011; 28:582-90. [PMID: 21564275 DOI: 10.1111/j.1540-8175.2011.01395.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intracardiac echocardiography (ICE) broadens the spectrum of available echocardiographic techniques and provides the operator direct visualization of cardiac structures in real time. ICE has clear advantages over fluoroscopy, transthoracic echocardiography, and transesophageal echocardiography as the imaging modality of choice in the cardiac catheterization and electrophysiological laboratories. With the development of steerable phased array catheters with low frequency and Doppler qualities, there is marked improvement in visualization of left-sided structures from the right heart. Appropriate utilization of ICE is likely to maximize safety and efficacy of complex interventional procedures and may improve patient outcomes. Future advances in ICE imaging will further improve the ease of device guidance and, in combination with new imaging modalities, could dramatically improve other applications of echocardiography which may result in improved patient outcomes. This review describes the technical evolution of ICE, the use of ICE in guiding percutaneous interventional procedures and possible future applications of ICE in the ever-growing field of interventional cardiology.
Collapse
Affiliation(s)
- Sheharyar Ali
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | | | | |
Collapse
|
6
|
Awad SM, Cao QL, Hijazi ZM. Intracardiac echocardiography for the guidance of percutaneous procedures. Curr Cardiol Rep 2009; 11:210-5. [DOI: 10.1007/s11886-009-0030-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Kutyifa V, Merkely B, Pozsonyi Z, Hosszú K, Szilágyi S, Balázs G, Tóth A, Sármán P, Gellér L. [Intracardiac echocardiography-guided cardiac tumor mass biopsy]. Orv Hetil 2008; 149:1857-9. [PMID: 18805775 DOI: 10.1556/oh.2008.28459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary cardiac tumors are rare and often occur without major symptoms. The appropriate therapy for cardiac tumors without metastasis is surgical resection and chemotherapy. However, for certain patients, when the tumor cannot be safely removed, biopsy is recommended since it allows histology examination and further therapeutical considerations. The aim of our case presentation is to describe the case of a 56-year-old woman, in whom cardiac tumor-mass was revealed because of recurrent pericardial fluids. The mass appeared to be non-resectable, therefore biopsy with an eventual histological examination was planned. Intracardiac echocardiography guided percutaneous biopsy was performed. Intracardiac ultrasound ensured accurate localization of the tumor, the catheter-based grasping device and the excision could be instantly monitored. This case demonstrates that an intracardiac ultrasound-guided tumor mass biopsy is a feasible method, which increases accuracy and ensures safety.
Collapse
Affiliation(s)
- Valentina Kutyifa
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Kardiológiai Központ, Budapest
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Aqel R, Dobbs J, Lau Y, Lloyd S, Gupta H, Zoghbi GJ. Transjugular biopsy of a right atrial mass under intracardiac echocardiographic guidance. J Am Soc Echocardiogr 2006; 19:1072.e5-8. [PMID: 16880106 DOI: 10.1016/j.echo.2006.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Indexed: 11/24/2022]
Abstract
Biopsy of cardiac tumors to obtain a tissue diagnosis has been performed under echocardiographic (transthoracic or transesophageal) or fluoroscopic guidance. We report successful transjugular biopsy of a right atrial mass using intracardiac echocardiographic guidance.
Collapse
Affiliation(s)
- Raed Aqel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA
| | | | | | | | | | | |
Collapse
|
9
|
Kort S. Intracardiac Echocardiography: Evolution, Recent Advances, and Current Applications. J Am Soc Echocardiogr 2006; 19:1192-201. [PMID: 16950482 DOI: 10.1016/j.echo.2006.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Indexed: 11/21/2022]
Affiliation(s)
- Smadar Kort
- Division of Cardiology, State University of New York, Stony Brook, New York 11794-8171, USA.
| |
Collapse
|
10
|
Sheikh I, Kumar D, Liu Z, Kantharia B, MacMillan R, Fyfe BS, Narula J, Vannan M. Novel uses of intracardiac echocardiography with a phased-array imaging catheter. J Am Soc Echocardiogr 2004; 16:1073-7. [PMID: 14566302 DOI: 10.1016/s0894-7317(03)00474-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A newer phased-array ultrasound imaging catheter (AcuNav, Siemens, Moutainview, Calif) provides comprehensive anatomic and physiologic data during cardiac interventions. The role of this catheter in percutaneous closure procedures, transseptal ablative procedures, and valvular interventions has been reported. We describe an expanded role of intracardiac echocardiography using AcuNav imaging catheter (Siemens) in 2 clinical situations.
Collapse
Affiliation(s)
- Imran Sheikh
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Liu Z, McCormick D, Dairywala I, Surabhi S, Goldberg S, Turi Z, Vannan MA. Catheter-based intracardiac echocardiography in the interventional cardiac laboratory. Catheter Cardiovasc Interv 2004; 63:63-71. [PMID: 15343570 DOI: 10.1002/ccd.20106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent advances in technology have engendered a renewed enthusiasm in the use of intracardiac echocardiography (ICE) to guide and assess cardiac interventions. AcuNav is a phased-array sector imaging probe equipped with color and spectral Doppler capabilities. Previous-generation imaging catheters yielded unfamiliar limited-depth radial images with no flow information. Current imaging technology such as the AcuNav has not only consolidated the role of ICE but opened newer applications in the interventional laboratory. ICE has clear advantages over transesophageal echocardiography as the imaging modality of choice in the cardiac catheterization and electrophysiological laboratories. We review the technical evolution of ICE and describe the expanded utility of the AcuNav imaging catheter during cardiac interventions.
Collapse
Affiliation(s)
- Zheng Liu
- Department of Cardiovascular Medicine and Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
12
|
Keller DI, Hunziker P, Buser P. Biopsy of right atrial angiosarcoma guided by transesophageal echocardiography. J Am Soc Echocardiogr 2002; 15:475-7. [PMID: 12019433 DOI: 10.1067/mje.2002.117629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
When an intracardiac mass is detected, a histologic examination is frequently needed before making critical treatment modality decisions. This demands an open-chest procedure, often with cardiopulmonary bypass, with its associated morbidity. We describe a closed-chest approach using echocardiographically guided catheter biopsy.
Collapse
Affiliation(s)
- Dagmar I Keller
- Department of Cardiology, University Hospital, Basel, Switzerland
| | | | | |
Collapse
|