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Lacalle-González C, Estrella Santos A, Landaeta Kancev LC, Castellano VM, Macia Palafox E, Paniagua Ruíz A, Luna Tirado J, Martínez-Amores B, Martínez Dhier L, Lamarca A. Management of non-hepatic distant metastases in neuroendocrine neoplasms. Best Pract Res Clin Endocrinol Metab 2023; 37:101784. [PMID: 37270333 DOI: 10.1016/j.beem.2023.101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Neuroendocrine neoplasms represent an uncommon disease with an increasing incidence. Thanks to improvements in diagnostic and therapeutic methods, metastases previously considered uncommon, such as bone metastases, or even very rare, such as brain, orbital and cardiac metastases, are more frequently found in daily practice. Due to the great heterogeneity of these neoplasms, there is a lack of high-quality evidence on the management of patients with these types of metastases. The aim of this review is to provide the current state of the art, reviewing neuroendocrine neoplasm specific studies and useful information from other tumor types and to propose a treatment recommendation with algorithms to consider in daily clinical practice.
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Affiliation(s)
- C Lacalle-González
- Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - A Estrella Santos
- Department of Endocrinology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - L C Landaeta Kancev
- Deparment of Nuclear Medicine, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - V M Castellano
- Deparment of Pathology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - E Macia Palafox
- Deparment of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - A Paniagua Ruíz
- Department of Endocrinology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - J Luna Tirado
- Deparment of Radiation Oncology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - B Martínez-Amores
- Medical Oncology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Spain.
| | - L Martínez Dhier
- Deparment of Nuclear Medicine, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - A Lamarca
- Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, Madrid, Spain; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Department of Medical Oncology, The Christie NHS Foundation, University of Manchester, Manchester, United Kingdom.
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2
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Peng X, Xiao Y, Guo Y, Zhu Z, Liao L, Liao X, Hu X, Fang Z, Li X, Zhou S. Clinical Significance of Angiographically Detectable Neovascularity in Patients with Cardiac Myxoma. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Myxomas are the most common primary cardiac tumors. Angiographically detectable neovascularity (ADN) of myxoma is increasingly being reported as a result of the use of coronary angiography (CAG) to detect coronary artery disease. However, the clinical significance
of these findings is not fully understood.Methods: We enrolled 59 patients with cardiac myxoma who also underwent CAG between January 2013 and October 2018. Patients were followed up for a mean of 28.9 months (range 1‐69 months). The clinical features, echocardiography measurements,
pathological examination findings, CAG results, and outcomes during follow-up were compared between patients with ADN and patients without ADN.Results: ADN was found in 25 patients (42.4%). The arteries feeding the ADN included the right coronary artery (n=15), the left circumflex
coronary artery (n=7), and both arteries (n=3). The patients with ADN had a higher proportion of eosinophils (3.2% vs. 2.2%, P=0.03) and higher low-density lipoprotein cholesterol level (2.7 mmol/L vs. 2.2 mmol/L, P=0.02). Myxoma pedicles were more likely to be located in the
interatrial septum in patients with ADN (96% vs. 73.5%, P=0.02). No significant correlation was observed between the groups in clinical manifestations, atrial arrhythmia, myxoma size, cardiac chamber size, left ventricular ejection fraction, and the prevalence of complication with coronary
artery disease [16% in the ADN group (n=4) vs. 20.6% in the non-ADN group (n=7), P=0.66]. However, patients with ADN tended to have a lower incidence of major adverse cardiac and cerebrovascular events on long-term follow-up (0% vs. 14.7%, P=0.07).Conclusion: CAG-detected
ADN in patients with cardiac myxoma is associated with a borderline lower rate of major adverse cardiac and cerebrovascular events.
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Affiliation(s)
- Xiaofan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanan Guo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhaowei Zhu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liyan Liao
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaobo Liao
- Department of Cardiovascular and Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinqun Hu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuping Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Luo L, Zhao W, Wang Y, Liu K. Cardiac angiosarcoma: A case report and review of the literature. Echocardiography 2021; 38:2083-2090. [PMID: 34806222 DOI: 10.1111/echo.15221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/18/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Primary cardiac tumors are extremely rare, among which malignancies comprise about 15-25%. As the most common type of primary cardiac malignancies, angiosarcomas tend to arise in the right heart, especially right atrium. In this case report, we presented a 32-year-old female with primary cardiac angiosarcoma in the right atrial appendage detected by transesophageal echocardiography, as it is difficult to display on conventional transthoracic echocardiography.
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Affiliation(s)
- Limin Luo
- Department of Echocardiography, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China
| | - Weipeng Zhao
- Department of Echocardiography, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China.,Department of Echocardiography, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China.,Department of Echocardiography, Zhongshan Hospital Fudan University, Shanghai, China
| | - Kun Liu
- Department of Pathology, Zhongshan Hospital Fudan University Xiamen Branch, Xiamen City, Fujian Province, China
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4
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Rathi VK, Czajka AT, Thompson DV, Doyle M, Tewatia T, Yamrozik J, Williams RB, Biederman RWW. Can cardiovascular MRI be used to more definitively characterize cardiac masses initially identified using echocardiography? Echocardiography 2018; 35:735-742. [DOI: 10.1111/echo.14017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vikas K. Rathi
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
- Bon Secours Health System; Richmond VA USA
| | - Anna T. Czajka
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
| | | | - Mark Doyle
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
| | - Tarun Tewatia
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
| | - June Yamrozik
- Cardiac MRI Center; Allegheny General Hospital; Pittsburgh PA USA
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Viteri Malone MA, Ares GR, De Velasco G, Brandão R, Lin X, Norton C, Simantov R, Moslehi J, Krajewski KM, Choueiri TK, McKay RR. The Clinical Presentation, Survival Outcomes, and Management of Patients With Renal Cell Carcinoma and Cardiac Metastasis Without Inferior Vena Cava Involvement: Results From a Pooled Clinical Trial Database and Systematic Review of Reported Cases. Clin Genitourin Cancer 2017; 16:e327-e333. [PMID: 29361425 DOI: 10.1016/j.clgc.2017.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/15/2017] [Accepted: 11/27/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cardiac metastases from renal cell carcinoma (RCC) are uncommon and there are limited data regarding the presentation and outcomes of this population. The objective of this study was to evaluate the characteristics and outcomes of patients with RCC with cardiac metastasis without inferior vena cava (IVC) involvement. MATERIALS AND METHODS We conducted a pooled retrospective analysis of metastatic RCC patients treated in 4 clinical trials. Additionally, we conducted a systematic review of cases reported in the literature from 1973 to 2015. Patients with cardiac metastases from RCC without IVC involvement were included. Patient and disease characteristics were described. Additionally, treatments, response to therapy, and survival outcomes were summarized. RESULTS Of 1765 metastatic RCC patients in the clinical trials database, 10 had cardiac metastases without IVC involvement. All patients received treatment with targeted therapy. There was 1 observed partial response (10%) and 6 patients showed stable disease (60%). The median progression-free survival was 6.9 months. The systematic review of reported clinical cases included 39 patients. In these patients, the most common cardiac site of involvement was the right ventricle (51%; n = 20). Patients were treated with medical (28%; n = 11) and/or surgical treatment (49%; n = 19) depending on whether disease was isolated (n = 13) or multifocal (n = 26). CONCLUSION To our knowledge, this is the first series to report on the presentation and outcomes of patients with cardiac metastasis without IVC involvement in RCC. We highlight that although the frequency of patients with cardiac metastases without IVC involvement is low, these patients have a unique clinical presentation and warrant special multidisciplinary management.
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Affiliation(s)
| | - Gustavo Ruiz Ares
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Raphael Brandão
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Xun Lin
- Pfizer Oncology, New York, NY
| | - Craig Norton
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Javid Moslehi
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, TN
| | | | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Rana R McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, La Jolla, CA.
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Abstract
In the past, cardiac tumors were a just clinical curiosity and the prognosis was poor. Surgical management became possible after the advent of cardiopulmonary bypass, and more recently, preoperative diagnosis was greatly improved by the development of echocardiography, computed tomography, and magnetic resonance imaging. The value of echocardiography for diagnosing cardiac mass lesions has become well established. Numerous advances have occurred in the last 5 decades, and the evolution of echocardiography involves the development of its many modalities. This review is intended to help echocardiologists and forensic pathologists in providing good medical practice when faced with the challenge of investigating unexpected clinical signs, particularly in young people, or unexpected postmortem findings.
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Spontaneous left atrial intramural hematoma associated with large hemorrhagic pericardial effusion. J Cardiol Cases 2016; 14:130-132. [PMID: 30524568 DOI: 10.1016/j.jccase.2016.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 11/22/2022] Open
Abstract
Atrial intramural hematoma is a rare entity. It was reported to occur spontaneously especially in patients with recent history of cardiac surgery or cardiac trauma. In this report, a case of spontaneous intramural hematoma associated with large bloody stained pericardial effusion presented with progressive shortness of breath as the primary clinical manifestation is described. The diagnosis was tentatively achieved by transesophageal echocardiography and cardiac computed tomography scan and was later confirmed during surgery. The patient recovered uneventfully following surgery and follow-up echocardiography demonstrated complete resolution of pre-existing hematoma. <Learning objective: We present a case of spontaneous intramural atrial hematoma and cardiac tamponade in a 61-year-old patient with a history of progressive shortness of breath. The proper diagnosis and surgical intervention are described. This case description will help increase the awareness regarding the diagnosis of this rare cardiac condition.>.
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Calissendorff J, Sundin A, Falhammar H. ⁶⁸Ga-DOTA-TOC-PET/CT detects heart metastases from ileal neuroendocrine tumors. Endocrine 2014; 47:169-76. [PMID: 24272595 DOI: 10.1007/s12020-013-0108-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/29/2013] [Indexed: 12/19/2022]
Abstract
Metastases from ileal neuroendocrine tumors (NETs) to the myocardium are rare and generally seen in patients with widespread metastatic NET disease. The objectives of this investigation were to describe the frequency of intracardiac metastases in ileal NET patients examined by (68)Ga-DOTA-TOC-PET/CT and to describe the cases in detail. All (68)Ga-DOTA-TOC-PET/CT examinations performed at the Karolinska University Hospital since 2010 until April 2012 were reviewed. In all, 128 out of 337 examinations were in patients with ileal NETs. Four patients had seven myocardiac metastases, yielding a frequency of 4.3 % in patients with ileal NETs. One patient had cardiac surgery while three were treated with somatostatin analogs. The cardiac metastases did not affect the patients' activity of daily life. (68)Ga-DOTA-TOC-PET/CT is an established imaging modality in identifying cardiac metastases in ileal NETs. Prospective studies are needed to confirm the true clinical value of (68)Ga-DOTA-TOC-PET/CT in detecting cardiac metastases in both ileal and non-ileal NETs.
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Affiliation(s)
- Jan Calissendorff
- Endocrine Section, VO Internmedicin, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, 118 83, Stockholm, Sweden,
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9
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Primary malignant cardiac tumors. J Cancer Res Clin Oncol 2014; 140:1047-55. [DOI: 10.1007/s00432-014-1651-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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10
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Pasalic D, Hegerova LT, Gonsalves WI, Robinson S. An insidious cardiac sarcoma presenting with progressive neurologic dysfunction. Rare Tumors 2014; 5:e56. [PMID: 24416490 PMCID: PMC3882928 DOI: 10.4081/rt.2013.e56] [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: 07/13/2013] [Revised: 08/09/2013] [Accepted: 08/11/2013] [Indexed: 11/23/2022] Open
Abstract
Central nervous system metastases as the presentation of primary cardiac sarcoma are a very rare entity, with only a few previously reported cases. Sarcomas specifically make up 10 to 20% of all primary cardiac tumors. Patients with primary cardiac tumors typically present with cardiac symptomatology that may include arrhythmias, obstruction to blood flow and valve function, or symptoms of heart failure. We report a unique case of a patient with a primary cardiac sarcoma who presented with progressive neurologic dysfunction secondary to brain metastases without any preceding cardiac symptoms. We describe our novel management of these unique cases and discuss the current medical and surgical approaches to treating neurologic metastases from cardiac sarcoma.
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Affiliation(s)
- Dario Pasalic
- Mayo Medical School, Mayo Clinic , Rochester, MN, USA
| | - Livia T Hegerova
- Department of General Internal Medicine, Mayo Clinic , Rochester, MN, USA
| | | | - Steven Robinson
- Division of Medical Oncology, Mayo Clinic , Rochester, MN, USA
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Abstract
Although echocardiography remains the standard diagnostic tool for identifying pericardial diseases, procedures with better delineation of morphology and heart function are often required. The pericardium consists of an inner visceral (epicardium) and outer parietal layer (pericardium), which constitute for the pericardial cavity. Pericardial effusion can occur as transudate, exudate, pyopneumopericardium, or hemopericardium. Potential causes are inflammatory processes, that is, pericarditis due to autoimmune or infective reasons, neoplasms, irradiation, or systemic disorders, chronic renal failure, endocrine, or metabolic diseases. Pericardial fat can mimic pericardial effusion. Using various image-acquisition sequences, MRI allows identifying and separating fluid and solid structures. Fast spin-echo T1-weighted sequences with black-blood preparation are favourably used for morphological evaluation. Fast spin-echo T2-weighted sequences, particularly with fat saturation, and short-tau inversion-recovery sequences are useful to visualize oedema and inflammation. For further tissue characterization, delayed inversion-recovery imaging is used. Therefore, image acquisition is performed at 5-20 min subsequent to contrast agent administration, the so-called technique of late gadolinium enhancement. Ventricular volumes and myocardial mass can be assessed accurately by steady-state free-precession sequences, which is required to measure cardiac function and ventricular wall stress. Constrictive pericarditis usually results from chronic inflammatory processes leading to increased stiffness, which impedes the slippage of both pericardial layers and thereby the normal cardiac filling. CT imaging can favourably assess pericardial calcification. Thus, MR and CT imaging allow a comprehensive delineation of the pericardium. Superior to echocardiography, both methods provide a larger field of view and depiction of the complete chest including abnormalities of the surrounding mediastinum and lungs. PET provides unique information on the in vivo metabolism of 18-fluorodeoxyglucose that can be superimposed on CT findings and is useful for identifying inflammatory processes or masses, for example neoplasms. These imaging techniques provide advanced information of anatomy and cardiac function to optimize the pericardial access, for example by the AttachLifter system, for diagnosis and treatment.
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12
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Vinicki JP, Cianciulli TF, Farace GA, Saccheri MC, Lax JA, Kazelian LR, Wachs A. Complete regression of myocardial involvement associated with lymphoma following chemotherapy. World J Cardiol 2013; 5:364-368. [PMID: 24109501 PMCID: PMC3783990 DOI: 10.4330/wjc.v5.i9.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/06/2013] [Accepted: 08/09/2013] [Indexed: 02/06/2023] Open
Abstract
Cardiac involvement as an initial presentation of malignant lymphoma is a rare occurrence. We describe the case of a 26 year old man who had initially been diagnosed with myocardial infiltration on an echocardiogram, presenting with a testicular mass and unilateral peripheral facial paralysis. On admission, electrocardiograms (ECG) revealed negative T-waves in all leads and ST-segment elevation in the inferior leads. On two-dimensional echocardiography, there was infiltration of the pericardium with mild effusion, infiltrative thickening of the aortic walls, both atria and the interatrial septum and a mildly depressed systolic function of both ventricles. An axillary biopsy was performed and reported as a T-cell lymphoblastic lymphoma (T-LBL). Following the diagnosis and staging, chemotherapy was started. Twenty-two days after finishing the first cycle of chemotherapy, the ECG showed regression of T-wave changes in all leads and normalization of the ST-segment elevation in the inferior leads. A follow-up Two-dimensional echocardiography confirmed regression of the myocardial infiltration. This case report illustrates a lymphoma presenting with testicular mass, unilateral peripheral facial paralysis and myocardial involvement, and demonstrates that regression of infiltration can be achieved by intensive chemotherapy treatment. To our knowledge, there are no reported cases of T-LBL presenting as a testicular mass and unilateral peripheral facial paralysis, with complete regression of myocardial involvement.
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Abstract
Isolated cardiac involvement in hydatid disease is very rare. We report the case of a young adult male who presented to the emergency department with acute onset of chest pain and was surprisingly detected to have a hydatid cyst in the left ventricular myocardium. The transthoracic echocardiography and cardiac magnetic resonance imaging confirmed the diagnosis. Cardiac hydatid disease should be considered in the differential diagnosis of chest pain in young individuals in the absence of conventional risk factors of atherosclerosis.
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Yohannan TM, Goldberg SP, Stamps JK, Mathis CA, Anthony CL, Lasater OE, Knott-Craig CJ. Cardiac myxolipoma in a child: diagnosis and surgical management. CONGENIT HEART DIS 2012; 7:E113-6. [PMID: 22613181 DOI: 10.1111/j.1747-0803.2012.00665.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case of a rare tumor, a myxolipoma, appearing in a 5-year-old child, along with the imaging evaluation and surgical management. The natural history is expected to be that of a benign lesion, but the rarity precludes large studies.
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Affiliation(s)
- Thomas M Yohannan
- Department of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN 38103, USA
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15
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Bauner KU, Sourbron S, Picciolo M, Schmitz C, Theisen D, Sandner TA, Reiser MF, Huber AM. MR first pass perfusion of benign and malignant cardiac tumours—significant differences and diagnostic accuracy. Eur Radiol 2011; 22:73-82. [DOI: 10.1007/s00330-011-2245-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 08/08/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
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18
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Abstract
MRI has acquired over the years a role in the evaluation of cardiovascular pathology especially with regards to its ability to assess right and left ventricular function and delayed postcontrast "viability" sequences. Current class I clinical indications include: viability for patients with ischemic cardiomyopathy and acute coronary syndrome, etiology and prognostic evaluation of non-ischemic cardiomyopathies including myocarditis and arrhytmogenic right ventricular cardiomyopathy, chronic pericarditis and cardiac masses, non-urgent aortic aneurysm and dissection, congenital cardiopathies: vascular malformations and follow-up after curative or palliative surgery. MRI provides a complete non operator dependent evaluation, and is particularly useful for follow-up since it may be repeated due to its absence of ionizing radiation
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Mariappan YK, Glaser KJ, Manduca A, Ehman RL. Cyclic motion encoding for enhanced MR visualization of slip interfaces. J Magn Reson Imaging 2009; 30:855-63. [PMID: 19787735 DOI: 10.1002/jmri.21914] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To develop and test a magnetic resonance imaging-based method for assessing the mechanical shear connectivity across tissue interfaces with phantom experiments and in vivo feasibility studies. MATERIALS AND METHODS External vibrations were applied to phantoms and tissue and the differential motion on either side of interfaces within the media was mapped onto the phase of the MR images using cyclic motion encoding gradients. The phase variations within the voxels of functional slip interfaces reduced the net magnitude signal in those regions, thus enhancing their visualization. A simple two-compartment model was developed to relate this signal loss to the intravoxel phase variations. In vivo studies of the abdomen and forearm were performed to visualize slip interfaces in healthy volunteers. RESULTS The phantom experiments demonstrated that the proposed technique can assess the functionality of shear slip interfaces and they provided experimental validation for the theoretical model developed. Studies of the abdomen showed that the slip interface between the small bowel and the peritoneal wall can be visualized. In the forearm, this technique was able to depict the slip interfaces between the functional compartments of the extrinsic forearm muscles. CONCLUSION Functional shear slip interfaces can be visualized sensitively using cyclic motion encoding of externally applied tissue vibrations.
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Rare pediatric cardiac tumor presentation. Pediatr Cardiol 2009; 30:1016-8. [PMID: 19495849 DOI: 10.1007/s00246-009-9476-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 04/19/2009] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
Abstract
A case of cardiac inflammatory pseudotumor with a unique presentation is reported. This especially rare case belongs to a subset of pseudotumor caused by an infectious etiology. Furthermore, it is unique in that the patient experienced unexplained sinus tachycardia, which resolved with resection of the tumor. This report also emphasizes the importance of multiple imaging methods combined with the usefulness of surgery for treatment and diagnosis.
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21
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Indications cliniques appropriées de l’IRM en pathologie cardio-vasculaire. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2009. [DOI: 10.1016/s1878-6480(09)70353-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bogaert J, Francone M. Cardiovascular magnetic resonance in pericardial diseases. J Cardiovasc Magn Reson 2009; 11:14. [PMID: 19413898 PMCID: PMC2685792 DOI: 10.1186/1532-429x-11-14] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 05/04/2009] [Indexed: 02/06/2023] Open
Abstract
The pericardium and pericardial diseases in particular have received, in contrast to other topics in the field of cardiology, relatively limited interest. Today, despite improved knowledge of pathophysiology of pericardial diseases and the availability of a wide spectrum of diagnostic tools, the diagnostic challenge remains. Not only the clinical presentation may be atypical, mimicking other cardiac, pulmonary or pleural diseases; in developed countries a shift for instance in the epidemiology of constrictive pericarditis has been noted. Accurate decision making is crucial taking into account the significant morbidity and mortality caused by complicated pericardial diseases, and the potential benefit of therapeutic interventions. Imaging herein has an important role, and cardiovascular magnetic resonance (CMR) is definitely one of the most versatile modalities to study the pericardium. It fuses excellent anatomic detail and tissue characterization with accurate evaluation of cardiac function and assessment of the haemodynamic consequences of pericardial constraint on cardiac filling. This review focuses on the current state of knowledge how CMR can be used to study the most common pericardial diseases.
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Affiliation(s)
- Jan Bogaert
- Department of Radiology, UZ Leuven, B-3000 Leuven, Belgium
| | - Marco Francone
- Department of Radiology, University of La Sapienza, Rome, Italy
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Paraiso H, Prasad M. Papular rash in the hand: a case report of atrial myxoma. Eur J Intern Med 2009; 20:e76-7. [PMID: 19393486 DOI: 10.1016/j.ejim.2008.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 09/16/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022]
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Atypical presentation of acute myeloid leukemia: cardiac myeloid sarcoma. Int J Hematol 2009; 89:693-8. [DOI: 10.1007/s12185-009-0313-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/23/2009] [Accepted: 03/27/2009] [Indexed: 12/11/2022]
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Simpson L, Kumar SK, Okuno SH, Schaff HV, Porrata LF, Buckner JC, Moynihan TJ. Malignant primary cardiac tumors: review of a single institution experience. Cancer 2008; 112:2440-6. [PMID: 18428209 DOI: 10.1002/cncr.23459] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary cardiac sarcomas are uncommon. The authors undertook to review the Mayo Clinic's experience with primary cardiac sarcomas consisting of 34 patients seen over a 32-year period. METHODS The patient database at the Mayo Clinic was searched to identify patients with malignant tumors of the heart seen during the 32-year period between 1975 and 2007. Thirty-four patients with primary cardiac sarcomas were identified and their medical records reviewed for details pertaining to presenting symptoms, staging modalities, treatment approaches, and outcomes. RESULTS Of the 34 patients, 17 were men and 17 were women. The median age was 44 years. The mean duration of symptoms at the time of diagnosis was 3.6 months. The most common histologic type was angiosarcoma (41%). The median follow-up for the entire group was 12 months (range, 0-61 months). The median survival for those who underwent a complete surgical excision was 17 months compared with 6 months for those in whom a surgical complete remission could not be achieved (P = .01). Patients with angiosarcoma had a lower survival compared with patients with other histologies (5 months vs 17 months; P = .01). The median survival of patients with metastatic disease was 5 months versus 15 months in patients without metastatic disease (P = .03 by the log-rank test). CONCLUSIONS Cardiac sarcomas remain a rare but lethal disease. Compared with extracardiac sarcomas, the prognosis for patients with cardiac sarcomas remains very poor. A complete surgical excision should be performed if possible. Innovative treatment strategies are required.
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Affiliation(s)
- Lijo Simpson
- Division of Medical Oncology, Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN 55905, USA
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26
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Ekmektzoglou KA, Samelis GF, Xanthos T. Heart and tumors: location, metastasis, clinical manifestations, diagnostic approaches and therapeutic considerations. J Cardiovasc Med (Hagerstown) 2008; 9:769-77. [DOI: 10.2459/jcm.0b013e3282f88e49] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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27
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Peregud-Pogorzelska M, Kaźmierczak J, Wojtarowicz A. Intracavitary mass as the initial manifestation of primary pericardial mesothelioma: a case report. Angiology 2007; 58:255-8. [PMID: 17495278 DOI: 10.1177/0003319707300379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 31-year-old woman presented with a 3-month history of progressing fatigue and effort dyspnea. Echocardiography depicted a tumor within the free wall of the right ventricle and right atrium, located on both sides of the tricuspid annulus. Computed tomography showed disseminated circular shadows sized up to 7 mm--most likely metastatic lesions--in both lungs. The diagnosis of low-grade mesothelioma bifasicum was confirmed with histopathologic and immunohistochemical studies of the samples taken by thoracoscopy from parietal pleura, lung tumor, and diaphragm region. Chemotherapy, which included gemcitabine and carboplatin, resulted in transient improvement of the clinical status of the patient and reduction of the tumor mass lasting several months followed by progression of the disease. Significant amounts of pleural fluid and huge tumors within both pleural cavities emerged. The patient died due to respiratory and circulatory insufficiency 11 months following the diagnosis.
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Stainback RF, Hamirani YS, Cooley DA, Buja LM. Tumors of the Heart. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Fieno DS, Saouaf R, Thomson LEJ, Abidov A, Friedman JD, Berman DS. Cardiovascular Magnetic Resonance of Primary Tumors of the Heart: A Review. J Cardiovasc Magn Reson 2006; 8:839-53. [PMID: 17060107 DOI: 10.1080/10976640600777975] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Overall, the prevalence of primary cardiac neoplasms is approximately 0.3% and these masses should be distinguished from the myriad of other primary and secondary processes that can occur in the heart. Tumors within, attached to, or near the heart can cause direct cardiac damage, can result in thrombus formation, can compromise blood flow and can embolize distally. Hence, proper diagnosis is clinically important. It has been suggested that cardiovascular magnetic resonance (CMR) imaging is a useful tool for diagnosing and characterizing cardiac tumors. In this report, we present a case example of a patient with a large, mobile right atrial myxoma imaged by CMR with results of histopathologic analysis after excision. We also demonstrate the utilization of CMR for characterization of cardiac lesions, review the basic characteristics of primary cardiac neoplasms, provide an overview of published cases describing use of CMR, and give suggested guidelines for imaging of cardiac masses with emphasis on diagnosis of cardiac tumors. CMR is an important technique for diagnosing and characterizing cardiac tumors.
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Affiliation(s)
- David S Fieno
- Cedars-Sinai Medical Center, Department of Medicine and Imaging, Los Angeles, California 90048, USA
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Abstract
Recent developments in magnetic resonance (MR) imaging of the heart have refocused attention on the potential of MR and continue to attract intense interest within the radiology and cardiology communities. Improvements in speed, image quality, reliability, and range of applications have evolved to the point where cardiac MR imaging is increasingly seen as a practical clinical tool. As is often the case with MR imaging, not all of the most powerful techniques are necessarily easy to master or understand, and many-nonspecialists and specialists alike-are challenged to stay abreast. This review covers some of the major milestones that have led to the current state of cardiac MR and attempts to put into context some concepts that, although technical, have a real impact on the diagnostic power of cardiac MR imaging. Topics discussed include functional imaging, myocardial viability and perfusion imaging, flow quantification, and coronary artery imaging. A review such as this can only scratch the surface of what is a dynamic interdisciplinary field, but the hope is that sufficient information and insight are provided to stimulate the motivated reader to take his or her interest to the next level.
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Affiliation(s)
- J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 10945 Le Conte Ave, Suite 3371, Los Angeles, CA 90095-7206, USA.
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Abstract
In contrast to primary cardiac tumors, which are less frequent and mostly benign in nature, the majority of intracardiac tumors are metastatic lesions. Cardiac ultrasound has evolved enormously since its emergence in the 1950s and is presently the modality of choice for imaging space-occupying lesions of the heart; it provides high quality, real-time images that are extremely valuable in the evaluation of cardiac masses. Although transthoracic echocardiography is an excellent initial diagnostic technique to evaluate and diagnose cardiac masses, transesophageal echocardiography provides superior image resolution and better visualization of cardiac masses in patients with suboptimal transthoracic echocardiography studies. Computed tomography and magnetic resonance imaging are additional tools used for cardiac imaging and may provide useful information in addition to that obtained by echocardiography, especially when the images obtained by the latter are suboptimal.
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Affiliation(s)
- Moluk Mirrasouli Ragland
- Department of Medicine, University of North Texas Health Science Campus, 855 Montgomery Road, 4 Floor, Fort Worth, Texas 76107, USA
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Abstract
Primary tumors of the heart are rare with an incidence of 0.0017% to 0.19% in unselected patients at autopsy. Of those tumors, cardiac myxomas are the most commonly seen and account for about 50% of primary cardiac tumors. About 75% to 85% of myxomas originate in the left atrium, 15% to 20% in the right atrium, and only rare cases have been reported of myxomas originating in the left and right ventricles (5%). We present 3 cases in which right-sided myxomas were diagnosed echocardiographically and review the literature on primary cardiac myxomas.
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Affiliation(s)
- Sumit Mittle
- Division of Cardiology, North Shore University Hospital, Manhasset, New York 11030, USA
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Orban M, Tousek P, Becker I, Augustin N, Firschke C. Cardiac malignant tumor as a rare cause of acute myocardial infarction. Int J Cardiovasc Imaging 2004; 20:47-51. [PMID: 15055820 DOI: 10.1023/b:caim.0000013161.51607.cd] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Acute myocardial infarction is predominantly caused by coronary artery atherosclerotic plaque rupture and subsequent occlusive thrombus formation. The recognition of less common causes of acute myocardial infarction is important because they may require a different treatment strategy. We report a patient with acute myocardial infarction without any angiographic evidence of coronary atherosclerosis and a left atrial mass detected on echocardiography. Therefore, coronary embolism from intracardiac thrombus or tumor was suspected. No additional manifestations of a potential tumor were found on thoracic, abdominal and cranial computed tomography. During subsequent cardiac surgery, a large tumor could be in toto resected and was diagnosed as a highly malignant leiomyosarcoma on histopathological evaluation.
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Affiliation(s)
- Marek Orban
- Deutsches Herzzentrum, Technische Universität München, Germany
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Affiliation(s)
- K Reynen
- Department of Internal Medicine II, University of Dresden, Heart Center Dresden, Dresden, Germany.
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Heyer CM, Kagel T, Lemburg SP, Bauer TT, Nicolas V. Lipomatous hypertrophy of the interatrial septum: a prospective study of incidence, imaging findings, and clinical symptoms. Chest 2004; 124:2068-73. [PMID: 14665481 DOI: 10.1378/chest.124.6.2068] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign disorder characterized by fat accumulation in the interatrial septum. It typically occurs in elderly, obese patients and may cause arrhythmia. OBJECTIVES The purpose of this study was to determine the imaging features of this cardiac pathology using multislice CT (MSCT), and its relationship with clinical findings. MATERIALS AND METHODS A total of 1,292 consecutive patients who underwent MSCT of the thorax from September 2001 to August 2002 were prospectively studied. Beside the analysis of patient records, the amount of fat in the interatrial septum, and its size and shape were determined. RESULTS Among the 1,292 patients investigated, we found 28 (2.2%) with LHIS. The mean age of affected patients was 72.2 years. MSCT studies revealed a mass of fat attenuation with sharp margins and sparing of the fossa ovalis, resulting in a dumbbell shape in all patients. The median thickness of the interatrial septum was 32 mm (range, 20 to 62 mm), and the median craniocaudal extend was 62 mm (range, 51 to 89 mm). Twenty-one patients (75.0%) showed increased epicardial fat, 18 patients (64.3%) had significant pulmonary emphysema, and 13 of 21 patients (61.9%) showed ECG abnormalities. Three patients underwent functional cardiac MRI studies. In one patient, hemodynamic obstruction by LHIS was shown. CONCLUSIONS MSCT scanning is a useful method to diagnose LHIS, a cardiac condition that in our series reached a 2.2% incidence. The lesion shows characteristic features, thus differentiating it from other cardiac tumors. Advanced age, obesity, pulmonary emphysema, and atrial arrhythmias are common additional findings in patients with LHIS.
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Affiliation(s)
- Christoph M Heyer
- Institute of Radiology and Nuclear Medicine, BG Kliniken Bergmannsheil, Ruhr-University of Bochum, Bürkle-de-la-Camp Platz 1, D-44789 Bochum, Germany.
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36
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Angiosarcomas cardíacos primarios: utilidad de la tomografía computarizada y la resonancia mágnética cardíaca en su diagnóstico. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77266-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bremerich J, Pater S, Buser PT. Magnetic resonance imaging of acquired heart disease: evaluation of structure. Semin Roentgenol 2003; 38:314-9. [PMID: 14621373 DOI: 10.1016/s0037-198x(03)00056-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jens Bremerich
- Departments of Radiology, and Cardiology, University of Basel, Basel, Switzerland
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38
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Shiraishi J, Tagawa M, Yamada T, Sawada T, Tatsumi T, Azuma A, Shimada Y, Yaku H, Kitamura N, Nakagawa M. Papillary Fibroelastoma of the Aortic Valve: Evaluation with Transesophageal Echocardiography and Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2003; 44:799-803. [PMID: 14587662 DOI: 10.1536/jhj.44.799] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 74-year-old Japanese male was admitted to hospital with episodes of chest pain. Cross-sectional echocardiography showed a mobile mass adherent to the noncoronary cusp of the aortic valve. We employed transesophageal echocardiography and magnetic resonance imaging to evaluate the mass. Based on the findings, a papillary fibroelastoma of the aortic valve was suspected. To avoid systemic embolization, urgent surgery was performed. The histopathologic diagnosis was papillary fibroelastoma. When a tumor of the aortic valve exists, these examinations are useful in detecting and characterizing the tumor for optimal treatment.
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Affiliation(s)
- Jun Shiraishi
- Second Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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39
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Pandya UH, Pellikka PA, Enriquez-Sarano M, Edwards WD, Schaff HV, Connolly HM. Metastatic carcinoid tumor to the heart: echocardiographic-pathologic study of 11 patients. J Am Coll Cardiol 2002; 40:1328-32. [PMID: 12383582 DOI: 10.1016/s0735-1097(02)02109-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We sought to investigate the clinical and echocardiographic (echo) characteristics of metastatic carcinoid tumor in the heart. BACKGROUND Right-sided valvular dysfunction is the hallmark of carcinoid heart disease. Cardiac metastases are uncommon in carcinoid syndrome. Features of patients with metastatic carcinoid tumor involving the heart (MCH) have not been well described. METHODS From 1985 through 1999, 11 patients (8 male, 3 female), mean age +/- standard deviation, 58 +/- 6 years, were seen who had pathologically confirmed MCH. All patients had echoes, which were reviewed retrospectively. RESULTS All patients with MCH had carcinoid syndrome. The primary carcinoid tumor was in the small bowel in 83% of patients, and all patients had hepatic metastases. On pathologic review, the 11 patients had 15 MCH tumors. All metastases were intramyocardial. The MCH involved the right ventricle in 40%, left ventricle in 53%, and ventricular septum in 7%. The average size of macroscopic tumors was 1.8 +/- 1.2 cm. Nine MCH tumors were detected by echo in 6 of the 11 patients (55%). Mean echo-detected tumor size was 2.4 cm (range, 1.2 to 4). All tumors noted by echo were well circumscribed, non-infiltrating, and homogeneous. In the 5 other patients, review of autopsy records revealed 6 macroscopic tumors, mean size 0.35 cm (range, 0.2 to 0.4), none detected by echo even retrospectively. Carcinoid valve disease was present in 8 of the 11 MCH patients. The tricuspid valve was affected in all 8 patients (73%), pulmonary valve in 7 (64%), and left sided valves in 4 (36%) All patients with MCH identified by echo had cardiac surgery, 3 primarily for carcinoid valve disease and 2 for non-carcinoid cardiac disease; in 1 patient, MCH was the primary indication for cardiac surgery. CONCLUSIONS MCH is uncommon but can be easily identified by echo if tumor size is >/=1.0 cm. In patients without valvular dysfunction, MCH may be the only manifestation of carcinoid heart disease. A search for MCH should be an integral part of the echo exam in patients with carcinoid syndrome.
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Affiliation(s)
- Utpal H Pandya
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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40
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Alvarez J, Rubio A, Mora MD, Fernández Madero G, Vivancos R, Malpartida F. [Diagnosis by magnetic resonance imaging of a case of intramural left atrial hematoma]. Rev Esp Cardiol 2002; 55:872-4. [PMID: 12199985 DOI: 10.1016/s0300-8932(02)76718-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of spontaneous intramural left atrial hematoma with chest pain and pulmonary edema as the primary clinical manifestations. Echocardiographic techniques revealed obstruction of the left atrial cavity by cyst-like masses attached to the posterior and anterior atrial wall. A large intramural hematoma due to extensive atrial wall dissection was observed by magnetic resonance imaging. Surgery confirmed the diagnosis of intramural left atrial hematoma with no complications. We review the clinical and diagnostic profile of the three cases of spontaneous intramural left atrial hematoma reported in the world medical literature.
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Affiliation(s)
- Jesús Alvarez
- Unidad de Cardiología, Hospital de Antequera, Malaga, Spain.
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41
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Kiaffas MG, Powell AJ, Geva T. Magnetic resonance imaging evaluation of cardiac tumor characteristics in infants and children. Am J Cardiol 2002; 89:1229-33. [PMID: 12008185 DOI: 10.1016/s0002-9149(02)02314-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Maria G Kiaffas
- Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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42
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Abstract
Magnetic resonance imaging (MRI) and computed tomography (CT) are important imaging modalities for the noninvasive characterization of cardiac and paracardiac masses. They are, in general, superior to other modalities (e.g., echocardiography) in their ability to delineate the exact location and the extent of the lesion and to demonstrate the effects of the lesion on surrounding structures. MRI and CT may also be helpful in suggesting a specific diagnosis, because some tumors have rather characteristic locations and appearances. In addition, both modalities can be extremely helpful in both treatment planning and posttreatment follow-up because they are noninvasive, reproducible, and enable detection of residual or recurrent mass.
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Affiliation(s)
- P R Schvartzman
- Department of Radiology, The Cleveland Clinic Foundation, OH, USA
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Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR. Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation. Radiographics 2000; 20:1073-103; quiz 1110-1, 1112. [PMID: 10903697 DOI: 10.1148/radiographics.20.4.g00jl081073] [Citation(s) in RCA: 331] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Primary cardiac and pericardial neoplasms are rare lesions and include both benign and malignant histologic types. Myxoma is the most frequent primary cardiac neoplasm, but other benign tumors include papillary fibroelastoma, rhabdomyoma, fibroma, hemangioma, lipoma, and paraganglioma. Cardiac sarcoma represents the second most common primary cardiac neoplasm. Lymphoma can also affect the heart primarily. Pericardial tumors that affect the heart include benign teratomas and malignant mesotheliomas. Patients affected with cardiac or pericardial neoplasms often present with cardiovascular compromise or embolic phenomena and exhibit cardiomegaly at chest radiography. Benign cardiac tumors typically manifest as intracavitary, mural, or epicardial focal masses, whereas malignant tumors demonstrate invasive features and may involve the heart diffusely. Benign lesions can usually be successfully excised, but patients with malignant lesions have an extremely poor prognosis.
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Affiliation(s)
- M L Grebenc
- Department of Radiology, National Naval Medical Center, Bethesda, MD, USA
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44
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Abstract
A young man with a short history of increasing dyspnea, cough, and ascites was initially diagnosed as having idiopathic constrictive pericarditis and referred for an operation. The procedure revealed an atypical invasive encapsulating disease. Complete resection was impossible, and only partial relief of constriction was achieved. The patient died shortly after. Histology revealed primary mesothelioma of the pericardium. The case illustrates the difficulty in establishing this diagnosis by echocardiography and computed tomography.
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Affiliation(s)
- D W Quinn
- Department of Cardiothoracic Surgery, Nottingham City Hospital, United Kingdom
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Abstract
Myxomas, particularly left-atrial myxomas, are the most common primary tumors of the heart that cardiac surgeons will be called upon to remove. Although some tumors are discovered incidentally during echocardiographic examination, many produce symptoms caused by the release of inflammatory cytokines, obstruction to intracardiac blood flow, and/or embolization. With rare exception, cardiac myxomas are benign, and excision is safe and curative in most patients. In a 38-year experience at the Mayo Clinic, 100 patients have had 106 operations for myxoma, and there has been only 1 perioperative death. During follow-up extending to 25 years, postoperative survival is similar to that of an age- and sex-matched population, and at 20 years postoperatively, 94% of patients were free of recurrent myxomas. Recognition of familial and syndrome myxomas (eg, Carney's complex) is important in guiding surgical approach, planning follow-up, and predicting recurrence of these unusual neoplasms.
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Affiliation(s)
- H V Schaff
- Division of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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46
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Bonamini R, Pinneri F, Cirillo S, Rosettani E, Mangiardi L. A large false aneurysm of the right ventricle within a giant epicardial lipoma. Chest 2000; 117:601-3. [PMID: 10669714 DOI: 10.1378/chest.117.2.601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Lipomas, which account for approximately 10% of all neoplasms of the heart, may be detected in asymptomatic patients by chance during echocardiography, CT scan, or MRI scan. Occasionally, lipomas are complicated by arrhythmias. We describe a patient who presented with severe cardiomegaly and paroxysmal supraventricular tachycardia. An MRI scan showed a large intrapericardial lipoma with two large cavities inside communicating with each other and with the right ventricular chamber through a defect of the right ventricular wall. The mass was partially removed, and the right ventricle was patched. Surgery combined with antiarrhythmic therapy resulted in a good short-term result.
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Affiliation(s)
- R Bonamini
- Dipartimento di Medicina Interna, Università di Torino, Torino,
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47
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Kaemmerer H, Ibrahim T, Schwaiger M, Hess J. [Magnetic resonance imaging and spiral computed tomography in the diagnosis and follow-up of adults with congenital heart and vessel disease]. Herz 1999; 24:263-75. [PMID: 10444706 DOI: 10.1007/bf03043878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Management of patients with congenital heart disease requires detailed information on cardiac and great vessel morphology. In previous years the diagnosis and treatment of congenital malformations often depended on cardiac catheterization and in many institutions cardiac catheterization still remains the gold standard against which other modalities are measured. In the past decade, however, imaging methodologies have increasingly shifted toward the use of less invasive and noninvasive techniques. Currently, echocardiography is the initial method of choice in evaluating the anatomy, especially in younger patients. Meanwhile, several newer imaging techniques like magnetic resonance imaging (MRI) and computed tomography (CT) are in use. They offer extremely useful information about abnormalities of the heart and great vessels as well as for the assessment of cardiac anatomy and function. Echo, angiography, MRT and CT should be seen as complementary investigations in adult congenital heart disease.
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Affiliation(s)
- H Kaemmerer
- Klinik für Kinderkardiologie und angeborene Herzfehler im Deutschen Herzzentrum München.
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48
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Mortele KJ, Mergo PJ, Williams WF. Lipomatous hypertrophy of the atrial septum: diagnosis with fat suppressed MR imaging. J Magn Reson Imaging 1998; 8:1172-4. [PMID: 9786157 DOI: 10.1002/jmri.1880080524] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a case of a 50-year-old female evaluated for a 1-year history of numbness of the first and second toe of the right foot. Echocardiography performed in order to exclude cardiovascular compromise revealed a granular mass originating from the posterior part of the interatrial septum. On subsequent magnetic resonance imaging (MRI) with fat suppression sequences, the final diagnosis of lipomatous hypertrophy of the interatrial septum, a benign and underrecognized condition characterized by septal accumulation of fatty tissue, was made. Although no previous reports have focused on this, tailored cardiac MR with fat suppression sequences proved to be an excellent noninvasive method in assessing an accurate diagnosis and in differentiating lipomatous hypertrophy of the atrial septum from other cardiac neoplasms.
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Affiliation(s)
- K J Mortele
- Department of Radiology, University of Florida College of Medicine, Gainesville 32610, USA
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49
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Kayser HW, de Roos A, van der Wall EE. Diagnosis of cardiac abnormalities in patients with nonischemic tachyarrhythmias: additional value of MR imaging. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1998; 14:279-85. [PMID: 9934616 DOI: 10.1023/a:1006008532380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To assess the contribution of cardiac magnetic resonance (MR) imaging in the evaluation of patients with nonischemic tachyarrhythmias and equivocal diagnosis following echocardiography and cardiac angiography. METHODS AND RESULTS Twenty-five patients with nonischemic tachyarrhythmias and equivocal diagnosis were studied using MR imaging. Before the MR examination all patients underwent two-dimensional echocardiography and cardiac catheterization. The type of additional information, obtained with MR imaging, ranged from confirming a suspected diagnosis in 5 patients (20%) to the identification of new important anatomic or functional information, allowing a correct diagnosis in 18 patients (72%). In two patients (8%) the MR diagnosis was incomplete. CONCLUSION MR imaging may be an important additional diagnostic tool in the evaluation of cardiac abnormalities in patients with nonischemic tachyarrhythmias.
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Affiliation(s)
- H W Kayser
- Department of Radiology, Leiden University Medical Center, The Netherlands
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50
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King MA, Vrachliotis TG, Bergin CJ. A left atrial pseudomass: potential pitfall at thoracic MR imaging. J Magn Reson Imaging 1998; 8:991-3. [PMID: 9702903 DOI: 10.1002/jmri.1880080431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We frequently observed a nodular soft-tissue structure in the region of the left atrium anterior to the orifice of the left inferior pulmonary vein on MR scans of the chest. To assess its morphologic characteristics and appearance, chest MR scans obtained in 49 patients were reviewed. ECG-gated conventional spin-echo T1-weighted and fast spin-echo (FSE) T2-weighted sequences were used. The location, morphology, and appearance of this soft-tissue structure was evaluated by two radiologists during one consensus reading. The pseudomass in the region of the left atrium was identified on the T1-weighted images in 25 of 49 patients. The structure was also identified on FSE T2-weighted images in 6 of these patients. On the T1-weighted images, its appearance was either linear (54%) or nodular (46%). In conclusion, a nodular soft-tissue mass anterior to the orifice of the left inferior pulmonary vein into the left atrium is a frequent finding on chest MR scans and should not be confused with an intra-atrial mass. Careful evaluation of the regional anatomy identifies this structure as extraluminal and helps to avoid misinterpretation of an intracardiac mass.
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Affiliation(s)
- M A King
- Department of Radiology, The Ohio State University Hospitals, Columbus 43210, USA.
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