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Soltani S, Garousi M, Mirzaee E, Koolaji S, Nazari H, Emami S, Zare Mehrjardi A, Arefpour AM. A rare presentation of primary cardiac myxofibrosarcoma: Case report and literature review. Cancer Rep (Hoboken) 2024; 7:e2033. [PMID: 38600050 PMCID: PMC11006601 DOI: 10.1002/cnr2.2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Primary cardiac myxofibrosarcoma is a rare and aggressive malignancy, with the majority of approaching strategies relying on case reports. This article provides insights into its diagnosis and treatment. CASE PRESENTATION This paper presents the case of a 40-year-old man with sudden onset hemoptysis, leading to the diagnosis of primary cardiac myxofibrosarcoma. Treatment involved open-heart surgery to excise the left atrium tumor, followed by 6 cycles of adjuvant chemotherapy. Unfortunately, brain metastasis developed, leading to the patient's death 1 year after initial diagnosis. CONCLUSION Primary cardiac myxofibrosarcoma remains a clinical challenge with an unfavorable prognosis. Early diagnosis through advanced imaging is crucial, and research is needed to explore innovative treatments. This case underscores the complexities of managing this rare cardiac malignancy and highlights the necessity for ongoing investigations to enhance patient outcomes.
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Affiliation(s)
- Sepideh Soltani
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
| | - Maryam Garousi
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
| | - Elahe Mirzaee
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
| | - Sogol Koolaji
- Non‐communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Hengameh Nazari
- Department of RadiologyIsfahan University of Medical SciencesIsfahanIran
| | - Sepideh Emami
- Department of Cardiology, Firoozgar Hospital, School of MedicineIran University of Medical SciencesTehranIran
| | - Ali Zare Mehrjardi
- Department of Pathology, Firoozgar HospitalIran University of Medical SciencesTehranIran
| | - Amir Mohammad Arefpour
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
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2
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Hoit BD. Benign or Malignant Cardiac Mass: Refining the Role of Cardiac Magnetic Resonance. Circ Cardiovasc Imaging 2024; 17:e016574. [PMID: 38502737 DOI: 10.1161/circimaging.124.016574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Brian D Hoit
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Department of Medicine, Case Western Reserve University, OH
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3
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Wang Q, Wang B, Zhang X, Zhong X, Chang S, Yang J, Liang J, You Q, Zhou H, Zhang J. The usefulness of contrast echocardiography in the evaluation of cardiac masses: a multicenter study. BMC Cardiovasc Disord 2024; 24:43. [PMID: 38218809 PMCID: PMC10787966 DOI: 10.1186/s12872-024-03708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Cardiac masses can encompass a variety of conditions, such as tumors, thrombi, vegetations, calcific lesions, and other rare diseases. Treatment and management of these types of cardiac masses differ considerably. Thus, accurately distinguishing among thrombi, benign tumors, and malignant tumors in the heart is of great importance. Contrast echocardiography (CE) has emerged as a promising technology. Although published guidelines suggest that CE can enhance image quality and assist in differentiating between benign and malignant lesions, most studies on CE diagnosis of cardiac masses are limited to case reports or retrospective/small-sample-sized prospective cohorts. This study aims to evaluate the diagnostic accuracy of CE in patients with suspected cardiac masses and address the insufficient evidence for differential diagnosis using CE. METHODS Between April 2018 and July 2022, a prospective multicenter study was conducted, which included 145 consecutive patients suspected to have cardiac masses based on transthoracic echocardiography. All patients underwent CE examinations. The echocardiographic diagnosis relied on qualitative factors such as echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility as well as quantitative factors such as the area of the masses and the peak intensity ratio of the masses to adjacent myocardium (A1/A2). RESULTS The final confirmed diagnoses were as follows: 2 patients had no cardiac mass, 4 patients had pseudomass, 43 patients had thrombus, 66 patients had benign tumors, and 30 patients had malignant tumors. The receiver operating characteristic (ROC) analysis indicated that an optimal A1/A2 cutoff value of 0.499 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.977, 97.9%, 90.7%, 95.9%, and 95.1%, respectively. The optimal A1/A2 cutoff value of 1.583 distinguished a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.950, 93.3%, 93.9%, 87.5%, and 96.9%, respectively. CONCLUSIONS Combined with qualitative and quantitative analyses, CE has the potential to accurately differentiate among different types of cardiac masses.
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Affiliation(s)
- Qingtao Wang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Bing Wang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Xiaofeng Zhang
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Xin Zhong
- Department of Ultrasound, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410002, China
| | - Shuai Chang
- Department of Ultrasound, First Affiliated Hospital of University of South China, Hengyang, 421001, China
| | - Jinbo Yang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Jian Liang
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Qiangqiang You
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China
| | - Heng Zhou
- Department of Cardio-Thoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China.
| | - Jiaqi Zhang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, China.
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4
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Avranas K, Eisenbach C, Flechtenmacher C, Korosoglou G. Diagnostic Pathway From Incidental Mass to Metastatic Melanoma: Role of Multimodal Imaging and Medical Therapy. JACC Case Rep 2024; 29:102146. [PMID: 38223263 PMCID: PMC10784600 DOI: 10.1016/j.jaccas.2023.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 01/16/2024]
Abstract
We present a case of detection of a right atrial mass during surveillance echocardiography, mimicking myxoma. Cardiac magnetic resonance and computed tomography revealed infiltration into the pericardium, suggesting malignancy. Abdominal computed tomography showed multiple liver masses that were histologically positive for metastatic amelanotic melanoma. Under immunotherapy adequate remission was achieved.
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Affiliation(s)
| | - Christoph Eisenbach
- Gesundheitszentren Rhein-Neckar Hospital Weinheim, Department of Gastroenterology and Diabetology, Weinheim, Germany
| | | | - Grigorios Korosoglou
- GRN Hospital Weinheim, Department of Cardiology, Vascular Medicine and Pneumology, Weinheim, Germany
- Weinheim Cardiac Imaging Center, Hector Foundation, Weinheim, Germany
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5
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Tagliati C, Fogante M, Palmisano A, Catapano F, Lisi C, Monti L, Lanni G, Cerimele F, Bernardini A, Procaccini L, Argalia G, Esposto Pirani P, Marcucci M, Rebonato A, Cerimele C, Luciano A, Cesarotto M, Belgrano M, Pagnan L, Sarno A, Cova MA, Ventura F, Regnicolo L, Polonara G, Uguccioni L, Quaranta A, Balardi L, Barbarossa A, Stronati G, Guerra F, Chiocchi M, Francone M, Esposito A, Schicchi N. Cardiac Masses and Pseudomasses: An Overview about Diagnostic Imaging and Clinical Background. Medicina (Kaunas) 2023; 60:70. [PMID: 38256331 PMCID: PMC10818366 DOI: 10.3390/medicina60010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/09/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information. Moreover, the increasingly performed coronary CT angiography to evaluate non-invasively coronary artery disease leads to a rising number of incidental findings. Therefore, CT and MRI are frequently performed imaging modalities when echocardiography is deemed insufficient to evaluate a lesion. A brief comprehensive overview about diagnostic radiological imaging and the clinical background of cardiac masses and pseudomasses is reported.
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Affiliation(s)
- Corrado Tagliati
- Radiologia, AST Pesaro Urbino, 61121 Pesaro, Italy; (C.T.); (A.R.)
| | - Marco Fogante
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (G.A.); (P.E.P.)
| | - Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.P.); (A.E.)
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giuseppe Lanni
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Federico Cerimele
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Antonio Bernardini
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Luca Procaccini
- Radiologia, ASL 4 Teramo, 64100 Teramo, Italy; (G.L.); (F.C.); (A.B.); (L.P.)
| | - Giulio Argalia
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (G.A.); (P.E.P.)
| | - Paolo Esposto Pirani
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (G.A.); (P.E.P.)
| | - Matteo Marcucci
- U.O.C. di Radiodiagnostica, Ospedale Generale Provinciale di Macerata, 62100 Macerata, Italy;
| | - Alberto Rebonato
- Radiologia, AST Pesaro Urbino, 61121 Pesaro, Italy; (C.T.); (A.R.)
| | - Cecilia Cerimele
- Dipartimento di Biomedicina e Prevenzione, Universiy of Roma Tor Vergata, 00133 Roma, Italy; (C.C.); (A.L.); (M.C.)
| | - Alessandra Luciano
- Dipartimento di Biomedicina e Prevenzione, Universiy of Roma Tor Vergata, 00133 Roma, Italy; (C.C.); (A.L.); (M.C.)
| | - Matteo Cesarotto
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina Ospedale di Cattinara, 34149 Trieste, Italy; (M.C.); (L.P.); (A.S.)
| | - Manuel Belgrano
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.B.); (M.A.C.)
| | - Lorenzo Pagnan
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina Ospedale di Cattinara, 34149 Trieste, Italy; (M.C.); (L.P.); (A.S.)
| | - Alessandro Sarno
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina Ospedale di Cattinara, 34149 Trieste, Italy; (M.C.); (L.P.); (A.S.)
| | - Maria Assunta Cova
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34151 Trieste, Italy; (M.B.); (M.A.C.)
| | | | - Luana Regnicolo
- Department of Neuroradiology, University Hospital of Marche, 60126 Ancona, Italy;
| | - Gabriele Polonara
- Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, 60126 Ancona, Italy;
| | - Lucia Uguccioni
- Emodinamica e Cardiologia Interventistica, AST Pesaro Urbino, 61121 Pesaro, Italy;
| | - Alessia Quaranta
- Cardiologia, Distretto Sanitario di Civitanova Marche, AST 3, 62012 Civitanova Marche, Italy;
| | - Liliana Balardi
- Health Professions Area, Diagnostic Technical Area, University Hospital of Marche, 60126 Ancona, Italy;
| | - Alessandro Barbarossa
- Cardiology and Arrhythmology Clinic, Department of Cardiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (A.B.); (G.S.); (F.G.)
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, Department of Cardiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (A.B.); (G.S.); (F.G.)
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Department of Cardiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (A.B.); (G.S.); (F.G.)
| | - Marcello Chiocchi
- Dipartimento di Biomedicina e Prevenzione, Universiy of Roma Tor Vergata, 00133 Roma, Italy; (C.C.); (A.L.); (M.C.)
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Italy; (F.C.); (C.L.); (L.M.); (M.F.)
- IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (A.P.); (A.E.)
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Nicolò Schicchi
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy;
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Kaemmerer AS, Suleiman MN, Agaimy A, Harig F, Weyand M, Tandler R. Rare Case Report: Left Atrial Sarcoma Obstructing the Left Ventricular Inflow. J Clin Med 2023; 12:6460. [PMID: 37892598 PMCID: PMC10607719 DOI: 10.3390/jcm12206460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Malignant cardiac tumors of the heart are extremely rare and may present tremendous diagnostic and therapeutic challenges. These tumors are able to infiltrate the heart and metastasize systemically. Early detection is often elusive as the clinical presentation is highly variable, posing significant diagnostic and therapeutic difficulties. Despite a multidisciplinary approach, the prognosis for patients with malignant cardiac tumors remains guarded. Early diagnosis and a multidisciplinary approach involving cardiac surgeons, oncologists and critical care specialists are crucial in the management of this disease. Further research is needed to better understand the pathomechanisms of tumor-related complications and to develop effective treatment strategies to improve patient outcomes. The rare case of a 78-year-old woman with left atrial tumor requiring emergency surgery for acutely developing mitral valve obstruction is presented. Pathology confirmed an undifferentiated pleomorphic sarcoma. This patient tragically did not survive, highlighting the difficulties of managing such a rare and deceptive heart disease.
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Affiliation(s)
- Ann-Sophie Kaemmerer
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.N.S.); (F.H.); (M.W.); (R.T.)
| | - Mathieu N. Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.N.S.); (F.H.); (M.W.); (R.T.)
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Frank Harig
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.N.S.); (F.H.); (M.W.); (R.T.)
| | - Michael Weyand
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.N.S.); (F.H.); (M.W.); (R.T.)
| | - René Tandler
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.N.S.); (F.H.); (M.W.); (R.T.)
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7
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Nóbrega S, Martins da Costa C, Amador AF, Justo S, Martins E. Cardiovascular Magnetic Resonance Versus Histopathologic Study for Diagnosis of Benign and Malignant Cardiac Tumours: A Systematic Review and Meta-Analysis. J Cardiovasc Imaging 2023; 31:159-168. [PMID: 37901993 PMCID: PMC10622638 DOI: 10.4250/jcvi.2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/27/2023] [Accepted: 08/06/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND The gold standard for diagnosis of cardiac tumours is histopathological examination. Cardiovascular magnetic resonance (CMR) is a valuable non-invasive, radiation-free tool for identifying and characterizing cardiac tumours. Our aim is to understand CMR diagnosis of cardiac tumours by distinguishing benign vs. malignant tumours compared to the gold standard. METHODS A systematic search was performed in the PubMed, Web of Science, and Scopus databases up to December 2022, and the results were reviewed by 2 independent investigators. Studies reporting CMR diagnosis were included in a meta-analysis, and pooled measures were obtained. The risk of bias was assessed using the Quality Assessment Tools from the National Institutes of Health. RESULTS A total of 2,321 results was obtained; 10 studies were eligible, including one identified by citation search. Eight studies were included in the meta-analysis, which presented a pooled sensitivity of 93% and specificity of 94%, a diagnostic odds ratio of 185, and an area under the curve of 0.98 for CMR diagnosis of benign vs. malignant tumours. Additionally, 4 studies evaluated whether CMR diagnosis of cardiac tumours matched specific histopathological subtypes, with 73.6% achieving the correct diagnosis. CONCLUSIONS To the best of our knowledge, this is the first published systematic review on CMR diagnosis of cardiac tumours. Compared to histopathological results, the ability to discriminate benign from malignant tumours was good but not outstanding. However, significant heterogeneity may have had an impact on our findings.
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Affiliation(s)
- Sandra Nóbrega
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Catarina Martins da Costa
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal
- Member of the European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands.
| | - Ana Filipa Amador
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal
- Member of the European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Sofia Justo
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisabete Martins
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal
- Member of the European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Portugal
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Inserra MC, Cannizzaro MT, Passaniti G, Celona A, Secinaro A, Curione D, D'Angelo T, Garretto O, Romeo P. MR imaging of primary benign cardiac tumors in the pediatric population. Heliyon 2023; 9:e19932. [PMID: 37809686 PMCID: PMC10559362 DOI: 10.1016/j.heliyon.2023.e19932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/25/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Primary cardiac tumors are rare in all ages, especially in children, with a reported prevalence range of 0.0017-0.28% in autopsy series. Due to their rarity, the diagnostic and therapeutic pathways reserved to them are usually described by single case reports, leading to the point where a common diagnostic protocol is imperative to obtain a differential diagnosis. The first diagnostic approach is done with transthoracic echocardiogram (TTE), due to its wide availability, low cost, absence of ionizing radiations and non-invasiveness. Several tumors are discovered incidentally and, in many cases, TTE is helpful to determine location, size and anatomical features, playing a key role in the differential diagnosis. In the last few years, cardiac magnetic resonance imaging (CMR) has had an increased role in the diagnostic pathway of pediatric cardiac masses, due to its high accuracy in characterizing mass tissue properties (especially for soft tissue), and in detecting tumor size, extent, pericardial/pleural effusion, leading to the correct diagnosis, treatment and follow-up. Therefore, nowadays, several consensus statements consider CMR as a leading imaging technique, thanks to its non-invasive tissue characterization, without the use of ionizing radiation, in an unrestricted field of view. As suggested by the most recent literature, the pediatric protocol is not so different from the adult one, adapted to the size and cardiac frequency of the patient, sometimes requiring special conditions such as free-breathing sequences and/or sedation or general anesthesia in non-cooperating patients.
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Affiliation(s)
| | | | - Giulia Passaniti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Antonio Celona
- UOC Radiodiagnostica, San Vincenzo Hospital, Provincial Health Agency of Messina, Taormina, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Curione
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, Messina Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Orazio Garretto
- UOSD Radiologia 2 CAST, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco”, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
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Cutaia A, Gaetani C, Fonio P, Faletti R. Role of integrated imaging in the diagnosis of an atypical and unresectable cardiac paraganglioma: a case report. Eur Heart J Case Rep 2023; 7:ytad363. [PMID: 37554962 PMCID: PMC10406452 DOI: 10.1093/ehjcr/ytad363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/08/2022] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Paragangliomas (PGLs) are rare neuroendocrine tumours that originate from extra-adrenal location. Cardiac PGLs can cause severe hypertension, palpitations, and lethal tachyarrhythmias. Diagnosis is based on measurement of plasma or urine metanephrines combined with conventional and nuclear imaging. Effective treatment is represented by surgical resection. We report a case of a 19-year-old patient with recurrent acute pericarditis; integrated imaging detected a large cardiac mass suggestive for PGL. CASE SUMMARY A 19-year-old male suffered pleuritic chest pain and fever for 4 days; electrocardiogram showed inferior ST elevation and transthoracic echocardiography a 2.2 cm pericardial effusion; these findings led to diagnose acute pericarditis. After a relapse of pericarditis, cardiac magnetic resonance and cardiac computed tomography (CCT) were performed, revealing a cardiac mass with radiological features of PGL. Blood and urine tests detected elevated levels of 3-methoxytyramine and chromogranin A. Gallium-68 positron emission tomography confirmed high metabolic activity of the mass. A negative 123-I-MIBG scintigraphy ruled out the possibility of radiometabolic treatment. A second CCT excluded the chance of surgical resection, due to intra-lesional course of the left anterior descending coronary artery. The young patient was referred to a different centre to achieve reduction of the mass, in order to potentially resect it afterwards. DISCUSSION Cardiac PGLs are rare tumours with significant morbidity related to norepinephrine secretion. In this case, without typical clinical manifestations and with no chance of surgical resection, integrated imaging played a central role in the differential diagnosis between PGL and other cardiac masses, providing both static and dynamic characterization.
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Affiliation(s)
- Aldo Cutaia
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Clara Gaetani
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Via Genova 3, 10126 Turin, Italy
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10
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Rout A, Vorla M, Aromiwura AA, Pahwa SV, Stoddard MF, Slaughter MS, Kalra DK. A Rapidly Growing Cardiac Mass-Malignant or Benign? CASE (Phila) 2023; 7:321-324. [PMID: 37614692 PMCID: PMC10442374 DOI: 10.1016/j.case.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
•Rapidly growing cardiac tumors can be benign or malignant. •Rarely, cardiac myxomas may grow rapidly, causing heart failure or obstructive symptoms. •Echocardiography remains the first-line imaging for cardiac tumors. •Multimodality imaging with CCT, CMR, and PET may aid in diagnosis.
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Affiliation(s)
- Amit Rout
- Division of Cardiology, University of Louisville, Louisville, Kentucky
| | - Mounica Vorla
- Division of Cardiology, University of Louisville, Louisville, Kentucky
| | | | - Siddharth V. Pahwa
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | | | - Mark S. Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Dinesh K. Kalra
- Division of Cardiology, University of Louisville, Louisville, Kentucky
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11
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Bae DH, Park S, Kim M, Kim S, Choi WG, Bae JW, Hwang KK, Kim DW, Cho MC, Lee JH. Cardiac osteosarcoma: a case report and literature review. Front Cardiovasc Med 2023; 10:1215389. [PMID: 37492160 PMCID: PMC10364321 DOI: 10.3389/fcvm.2023.1215389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/16/2023] [Indexed: 07/27/2023] Open
Abstract
Background Primary cardiac tumors are rare, and malignant primary cardiac tumors are even rarer. Cardiac osteosarcoma is a very rare type of malignant primary cardiac tumor with limited reported cases. We present a case report of cardiac osteosarcoma and review its characteristics and the related literature. Case summary A 44-year-old female patient without a specific medical history presented with intermittent dyspnea that started 1 month prior to presentation. A heterogeneous mass was observed in the left atrium on echocardiography and a large mass was observed in the left atrium on computed tomography. Surgery was performed under the suspicion of atypical cardiac myxoma, and the tumor was successfully removed. However, postoperative histopathological examination revealed cardiac osteosarcoma. The patient underwent chemotherapy and has been well maintained without recurrence for 10 years. Conclusion We present a case report of the echocardiographic features and treatment strategies for cardiac osteosarcoma, an extremely rare cardiac tumor. Multimodal imaging can be helpful; however, a histological diagnosis through surgical resection is essential. Appropriate treatment and follow-up based on histological findings are necessary.
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Affiliation(s)
- Dae-Hwan Bae
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sangshin Park
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Min Kim
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sangmin Kim
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Woong Gil Choi
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jang-Whan Bae
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyung-Kuk Hwang
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Dong-Woon Kim
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Myeong-Chan Cho
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ju-Hee Lee
- Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
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12
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Grazzini G, Pradella S, Rossi A, Basile RP, Ruggieri M, Galli D, Palmisano A, Palumbo P, Esposito A, Miele V. Practical Guide to Interpreting Cardiac Magnetic Resonance in Patients with Cardiac Masses. J Cardiovasc Dev Dis 2023; 10:229. [PMID: 37367394 DOI: 10.3390/jcdd10060229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
It is common for a cardiac mass to be discovered accidentally during an echocardiographic examination. Following the relief of a cardiac mass, being able to evaluate and characterize it using non-invasive imaging methods is critical. Echocardiography, computed tomography (CT), cardiac magnetic resonance imaging (CMR), and positron emission tomography (PET) are the main imaging modalities used to evaluate cardiac masses. Although multimodal imaging often allows for a better assessment, CMR is the best technique for the non-invasive characterization of tissues, as the different MR sequences help in the diagnosis of cardiac masses. This article provides detailed descriptions of each CMR sequence employed in the evaluation of cardiac masses, underlining the potential information it can provide. The description in the individual sequences provides useful guidance to the radiologist in performing the examination.
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Affiliation(s)
- Giulia Grazzini
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Alice Rossi
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Rocco Pio Basile
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Matteo Ruggieri
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Daniele Galli
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Anna Palmisano
- Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20100 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100 L'Aquila, Italy
| | - Antonio Esposito
- Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20100 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50134 Florence, Italy
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13
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Gholinataj Jelodar M, Mirzaei S, Dehghan Chenari H, Tabkhi M. Diagnosis of the right atrial myxoma after treatment of COVID-19: A case report. Clin Case Rep 2023; 11:e7216. [PMID: 37143454 PMCID: PMC10152069 DOI: 10.1002/ccr3.7216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
Key Clinical Message Atrial myxoma is a rare disease but has a broad clinical presentation and complication that involves several systems- heart, lungs, brain, and systemic. An interdisciplinary approach is very important to optimize the outcome in patients with atrial myxomas. A thorough examination by primary care providers is crucial. Then radiologists or cardiologists can help with imaging modalities that can help diagnose and characterize the tumor. Prior to surgical resection by cardiothoracic surgeons, patients need to be evaluated by pulmonologists, cardiologists, and anesthesiologists for preoperative risk stratifications. In patients with neurological complications, pulmonary complications, or infectious endocarditis, input from neurologists, hematologists, infectious disease specialists is essential for patient care. In case antiplatelet/anticoagulation therapy or antibiotic treatment is warranted, pharmacists can provide valuable recommendations. Abstract Myxoma is the most common benign cardiac primary tumor, occurring in the right atrium in only 15%-20% of cases. This disease is asymptomatic initially depending upon size of the tumor, and symptoms develop as the tumor spreads. Atrial myxomas are associated with a triad of complications, including obstruction, emboli, and constitutional symptoms (such as fever and weight loss). This regard, embolization of the pulmonary circulation system is a complication of right myxoma. The patient was a 40-year-old male who presented to the emergency department complaining of fever and confusion. He had been previously hospitalized due to COVID-19 and treated with Remdesivir and plasmapheresis. He had tachycardia, tachypnea, thrombocytopenia, and increased liver enzymes. Chest imaging showed nodular lesions with necrotic areas and cavitary lesions in both lungs and the right atrium infected clot was seen in echocardiography. He was treated with intravenous antibiotics and finally underwent heart surgery due to the diagnosis of pulmonary septic embolism. The patient was finally diagnosed with right atrial myxoma according to heart mass histopathology. It is worth noting that the patient's thrombosis had already developed on the right atrial myxoma, which delayed the diagnosis in this patient. This thrombus formation was due to the hypercoagulability state of COVID-19 and following the insertion of a central venous catheter to perform plasmapheresis as a complication of treatment. Special attention should be paid to thromboprophylaxis and the early diagnosis of intravascular and intracardiac thrombosis in COVID-19 patients. Furthermore, the use of imaging modalities is recommended to differentiate thrombus from myxoma.
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Affiliation(s)
| | - Samaneh Mirzaei
- Department of Health in Emergencies and Disasters, School of Public HealthShahid Sadoughi University of Medical SciencesYazdIran
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14
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Castro-Martín JJ, Di Silvestre-Alonso MA, Rivero-García M, Muñoz-Rodríguez R, Izquierdo-Gómez MM, Baeza-Garzón F, Lacalzada-Almeida J. Magnetic Resonance Imaging in the Study of Cardiac Masses: A Case Series. Medicina (B Aires) 2023; 59:medicina59040705. [PMID: 37109663 PMCID: PMC10144986 DOI: 10.3390/medicina59040705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023] Open
Abstract
Cardiac masses are currently studied using multimodality imaging. For diagnosis, different imaging techniques that can provide complementary information are used. Cardiac magnetic resonance imaging (MRI) has become a fundamental tool for this type of pathology owing to its ability to provide tissue characterization, spatial accuracy, and the anatomic relationships of the different structures. This study presents a series of four clinical cases with an initial diagnosis of a cardiac mass. All cases were evaluated at a single center, and patients were aged 57 to 72 years. An etiological study was conducted on all patients using different imaging techniques, including MRI. This study describes the diagnostic and therapeutic procedures of the four cases, which included two intracardiac metastases and two benign tumors. Cardiac MRI was decisive in the diagnostic process, determining the clinical decision-making in all four cases. Cardiac MRI has emerged as a pivotal technique in the diagnosis of cardiac masses. It can provide a highly accurate histological diagnosis without the need for invasive techniques.
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Affiliation(s)
- Jorge Joaquín Castro-Martín
- Cardiac Imaging Unit, Department of Cardiology, Canary Islands University Hospital (HUC), 38320 Santa Cruz de Tenerife, Spain
| | | | - Manuel Rivero-García
- Cardiac Imaging Unit, Department of Cardiology, Canary Islands University Hospital (HUC), 38320 Santa Cruz de Tenerife, Spain
| | - Rebeca Muñoz-Rodríguez
- Cardiac Imaging Unit, Department of Cardiology, Canary Islands University Hospital (HUC), 38320 Santa Cruz de Tenerife, Spain
| | - María Manuela Izquierdo-Gómez
- Cardiac Imaging Unit, Department of Cardiology, Canary Islands University Hospital (HUC), 38320 Santa Cruz de Tenerife, Spain
| | - Flor Baeza-Garzón
- Cardiac Imaging Unit, Department of Cardiology, Canary Islands University Hospital (HUC), 38320 Santa Cruz de Tenerife, Spain
| | - Juan Lacalzada-Almeida
- Cardiac Imaging Unit, Department of Cardiology, Canary Islands University Hospital (HUC), 38320 Santa Cruz de Tenerife, Spain
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15
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Sasahara H, Yatsu S, Wada H, Sai E, Moriya S, Miyazaki S, Kajimoto K, Ogita M, Suwa S. Multiple Imaging and Surgical Characteristics in Cardiac Metastasis from Undifferentiated Uterine Sarcoma. Case Rep Cardiol 2022; 2022:1-5. [PMID: 36407789 PMCID: PMC9674408 DOI: 10.1155/2022/6025354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
Although cardiac metastasis of malignant tumors has often been reported, undifferentiated uterine sarcoma (UUS) is a rare and aggressive uterine tumor. Thus, little is known of the UUS as a primary site of cardiac metastasis. We report a case of a 66-year-old woman, with a history of uterine myoma for 30 years, who was hospitalized with a large uterine tumor and cardiac masses. Although we investigated cardiac masses using imaging modalities, such as ultrasound, cardiac computer tomography, and magnetic resonance imaging, it was challenging to determine the masses as metastasis or thrombi. Cardiac masses were removed by surgery to assess the tissue characteristics and were later identified as tumors due to their appearance. Then, pathological findings revealed that UUS spreads to the right ventricle. We attempted chemotherapy after surgery; however, the disease progressed very quickly and the patient died on the 49th day of admission. In this report, we described the case of a patient with a difficult diagnosis and rapid disease progression of cardiac metastasis from UUS.
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16
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Tinoco M, Castro F, Leite S, Sousa F, Lourenço A. Peek-A-Boo What are You? The Diagnostic Challenge of a Cardiac Mass. Arq Bras Cardiol 2022; 119:616-618. [PMID: 36287416 PMCID: PMC9563897 DOI: 10.36660/abc.20211033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mariana Tinoco
- Hospital da Senhora da Oliveira Guimarães EPEGuimarãesPortugal Hospital da Senhora da Oliveira Guimarães EPE , Guimarães – Portugal
| | - Filipa Castro
- Hospital da Senhora da Oliveira Guimarães EPEGuimarãesPortugal Hospital da Senhora da Oliveira Guimarães EPE , Guimarães – Portugal ,Hospital da LuzGuimarãesPortugal Hospital da Luz , Guimarães – Portugal
| | - Sérgio Leite
- Hospital da Senhora da Oliveira Guimarães EPEGuimarãesPortugal Hospital da Senhora da Oliveira Guimarães EPE , Guimarães – Portugal
| | - Francisco Sousa
- Hospital da Senhora da Oliveira Guimarães EPEGuimarãesPortugal Hospital da Senhora da Oliveira Guimarães EPE , Guimarães – Portugal ,Hospital da LuzGuimarãesPortugal Hospital da Luz , Guimarães – Portugal
| | - António Lourenço
- Hospital da Senhora da Oliveira Guimarães EPEGuimarãesPortugal Hospital da Senhora da Oliveira Guimarães EPE , Guimarães – Portugal
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17
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Pino PG, Moreo A, Lestuzzi C. Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach. J Clin Ultrasound 2022; 50:1177-1193. [PMID: 36218203 PMCID: PMC9828386 DOI: 10.1002/jcu.23309] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cardiac tumors may be primary (either benign or malignant) or secondary (malignant) and are first detected by echocardiography in most cases. The cardiologist often challenges their identification, the differential diagnosis and the best therapeutic approach. Malignant tumors have usually a poor prognosis, which may be significantly improved by appropriate and timely therapies. The echocardiographic aspects of benign and malignant cardiac tumors described in this article, along with a clinical evaluation may orient the differential diagnosis and aid in choosing the further steps useful to define the nature of the mass.
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Affiliation(s)
- Paolo G. Pino
- Former Chief of Non Invasive Cardiovascular Diagnostics DepartmentOspedale San CamilloRomeItaly
| | - Antonella Moreo
- Cardiology IV, 'A.De Gasperis'DepartmentNiguarda Ca' Granda HospitalMilanItaly
| | - Chiara Lestuzzi
- Cardio‐oncological Rehabilitation Service, Azienda Sanitaria Friuli Occidentale (ASFO)c/o National Cancer Institute (CRO), IRCCSAvianoItaly
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18
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Li Y, Ren W, Wang X, Xiao Y, Feng Y, Shi P, Sun L, Wang X, Yang H, Song G. The diagnostic accuracy of contrast echocardiography in patients with suspected cardiac masses: A preliminary multicenter, cross-sectional study. Front Cardiovasc Med 2022; 9:1011560. [PMID: 36187014 PMCID: PMC9523017 DOI: 10.3389/fcvm.2022.1011560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background To evaluate the diagnostic accuracy of contrast echocardiography (CE) in patients with suspected cardiac masses. Methods A multicenter, prospective study involving 108 consecutive patients with suspected cardiac masses based on transthoracic echocardiography performed between November 2019 and December 2020 was carried out. CE examinations were performed in all patients. The echocardiographic diagnosis was established according to the qualitative (echogenicity, boundary, morphology of the base, mass perfusion, pericardial effusion, and motility) and quantitative (area of the masses and peak intensity ratio of the masses and adjacent myocardium A1/A2) evaluations. Results Final confirmed diagnoses were as follows: no cardiac mass (n = 3), pseudomass (n = 3), thrombus (n = 36), benign tumor (n = 30), and malignant tumor (n = 36). ROC analysis revealed the optimal A1/A2 with cutoff value of 0.295 for a cardiac tumor from a thrombus, with AUC, sensitivity, specificity, PPV, and NPV of 0.958 (95% confidence interval (CI): 0.899–0.988), 100, 91.7, 95.7, and 100%, respectively. CE was able to distinguish malignant from benign tumors with an AUC of 0.953 (95% CI: 0.870–0.990). Multivariate logistic regression analysis revealed that tumor area, base, and A1/A2 were associated with the risk of malignant tumor (OR = 1.003, 95% CI: 1.00003–1.005; OR = 22.64, 95% CI: 1.30–395.21; OR = 165.39, 95% CI: 4.68–5,850.94, respectively). When using A1/A2 > 1.28 as the only diagnostic criterion to identify the malignant tumor, AUC, sensitivity, specificity, PPV, and NPV were 0.886 (95% CI: 0.784–0.951), 80.6, 96.7, 96.7, and 80.7%, respectively. Conclusion CE has the potential to accurately differentiate cardiac masses by combining qualitative and quantitative analyses. However, more studies with a large sample size should be conducted to further confirm these findings. Clinical trial registration http://www.chictr.org.cn/, identifier: ChiCTR1900026809.
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Affiliation(s)
- Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yueqin Feng
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Pengli Shi
- Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Lijuan Sun
- Department of Ultrasound, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiao Wang
- Department of Ultrasound, Anshan Central Hospital, Anshan, China
| | - Huan Yang
- Department of Ultrasound, Yingkou Central Hospital, Yingkou, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Guang Song
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19
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Luca AC, Miron IC, Cojocaru E, Țarcă E, Curpan A, Mihăila D, Mihaela Trandafir L, Iordache A, Lupu V, Tazelaar HD, Pădureț IA. Cardiac Rhabdoid Tumor—A Rare Foe—Case Report and Literature Review. Children 2022; 9:942. [PMID: 35883926 PMCID: PMC9323533 DOI: 10.3390/children9070942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022]
Abstract
Intracardiac masses are unusual findings in infants, and most of them are benign. Nevertheless, they may be associated with a significant degree of hemodynamic instability and/or arrhythmias. Malignant tumors of the heart rarely occur in children. Rhabdoid tumors are aggressive tumors with a dismal prognosis even when diagnosed early. Although rhabdomyomas are common cardiac tumors in infants, they are mostly benign. The most common sites of involvement are the kidneys and central nervous system, but soft tissues, lungs, and ovaries may also be affected. The diagnosis can be challenging, particularly in sites where they do not usually occur. In the present paper, we report the case of a 2-year-old boy diagnosed with cardiac rhabdoid tumor highlighting the importance of molecular studies and recent genetic discoveries with the purpose of improving the management of such cases. The aim of this educational case report and literature review is to raise awareness of cardiac masses in children and to point out diagnostic hints toward a cardiac tumor on various imaging modalities. Given the rarity of all tumors involving the heart and the lack of symptom specificity, a high degree of suspicion is needed to arrive at the correct diagnosis.
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20
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Javeed M, Gruhonjic H, Patel D, Forcella J, Akel R. Massive Mural Thrombus Masquerading as Myxoma. Cureus 2022; 14:e25440. [PMID: 35774663 PMCID: PMC9237856 DOI: 10.7759/cureus.25440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/06/2022] Open
Abstract
A 75-year-old Caucasian female with a past medical history including insulin-dependent diabetes mellitus, hypertension, and dyslipidemia, presented to the emergency room for having palpitations for three weeks. Echocardiography revealed a very large left atrial mass mimicking myxoma. Mass was excised and examined by pathology, revealing a mural thrombus. A mural thrombus is not an uncommon mass found in the left atrium. However, it does not often present symptomatically, strongly mimics an atrial myxoma on cardiac imaging, and has rarely ever been reported to be greater than seven centimeters in any dimension. We present a case of a 75-year-old Caucasian woman with a massive, symptomatic cardiac thrombus masquerading as a myxoma on imaging.
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21
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Mahalwar G, Barve N, Furqan MM, Reyaldeen RM, Kumar A, Collier P, Klein AL. Role of Echocardiography in Diagnosing Metastatic Testicular Carcinoma in a Young Patient Presenting as Right Heart Failure. CASE 2022; 6:63-66. [PMID: 35492298 PMCID: PMC9050579 DOI: 10.1016/j.case.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Metastatic GCTs may initially present as right heart failure. TTE and TEE can diagnose cardiac metastasis and monitor cardiac function. Multimodality imaging informs about tumor burden in metastatic cardiac tumors.
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Affiliation(s)
| | | | - Muhammad M. Furqan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Reza M. Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ashwin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Collier
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- Reprint requests: Allan L. Klein, MD, Pericardial Disease Center, Department of Cardiovascular Medicine Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195.
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22
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Ma H, Niu Y, Tian M, Liu L, Gong W, Zheng M. A study of 399 cardiac tumors: Characteristics of echocardiography and pathological features. Echocardiography 2021; 39:37-45. [PMID: 34913194 DOI: 10.1111/echo.15249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/21/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS This study aimed to summarize the transthoracic echocardiography (TTE) characteristics of cardiac tumors with different pathologies. METHODS The data of 399 patients with cardiac tumors confirmed by pathology, who had undergone surgical resection were consecutively collected in our hospital between January 1, 2011 and December 31, 2019. The TTE characteristics were summarized and compared with the pathology. RESULTS Mean patient age was 49.8±15.7 years (22 children and 377 adults), and 62.2% were female. Of the tumors, 90.5% (361) were primary and 9.5% (38) were secondary. Further, 88.7% (354) were benign and 11.3% (45) were malignant. Of the primary tumors (96.1% benign and 3.9% malignant), 84.2% were myxomas, followed by 3.5% lipomas and 1.5% fibromas in adults, while in children, 31.8% were rhabdomyomas and 22.7% were fibromas. The most common type of secondary cardiac tumor was malignant liver carcinoma metastasis (39.5%) and benign intravenous leiomyomatosis with cardiac extension from the uterus (18.4%). TTE features of myxoma showed four variation types among 8.9% of myxomas: liquefaction (anechoic region mostly), calcification (hyperechoic range with a shadow), multiple nodules, and high proliferative activity (a large irregular mass with a wide base and a high Ki67 index). The TTE characteristics of some common benign non-myxoma tumors had specific findings. The TTE features of malignant tumors mostly showed hypoechogenicity, an unclear boundary, a wide basement, and multi-chambers or tissue invasion. CONCLUSIONS Most cardiac tumors have typical ultrasonic manifestations. Preoperative echocardiography could roughly judge cardiac tumor type and may be helpful for guiding clinical treatment decisions.
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Affiliation(s)
- Hui Ma
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yicui Niu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Mingjun Tian
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lu Liu
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Wenqing Gong
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Minjuan Zheng
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Gatti M, D’Angelo T, Muscogiuri G, Dell'aversana S, Andreis A, Carisio A, Darvizeh F, Tore D, Pontone G, Faletti R. Cardiovascular magnetic resonance of cardiac tumors and masses. World J Cardiol 2021; 13:628-649. [PMID: 34909128 PMCID: PMC8641001 DOI: 10.4330/wjc.v13.i11.628] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/19/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac masses diagnosis and treatment are a true challenge, although they are infrequently encountered in clinical practice. They encompass a broad set of lesions that include neoplastic (primary and secondary), non-neoplastic masses and pseudomasses. The clinical presentation of cardiac tumors is highly variable and depends on several factors such as size, location, relation with other structures and mobility. The presumptive diagnosis is made based on a preliminary non-invasive diagnostic work-up due to technical difficulties and risks associated with biopsy, which is still the diagnostic gold standard. The findings should always be interpreted in the clinical context to avoid misdiagnosis, particularly in specific conditions (e.g., infective endocarditis or thrombi). The modern multi-modality imaging techniques has a key role not only for the initial assessment and differential diagnosis but also for management and surveillance of the cardiac masses. Cardiovascular magnetic resonance (CMR) allows an optimal non-invasive localization of the lesion, providing multiplanar information on its relation to surrounding structures. Moreover, with the additional feature of tissue characterization, CMR can be highly effective to distinguish pseudomasses from masses, as well as benign from malignant lesions, with further differential diagnosis of the latter. Although histopathological assessment is important to make a definitive diagnosis, CMR plays a key role in the diagnosis of suspected cardiac masses with a great impact on patient management. This literature review aims to provide a comprehensive overview of cardiac masses, from clinical and imaging protocol to pathological findings.
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Affiliation(s)
- Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Tommaso D’Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, “G. Martino” University Hospital Messina, Messina 98100, Italy
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan 20149, Italy
| | | | | | - Andrea Carisio
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Italy
| | - Davide Tore
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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24
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Sonaglioni A, Albini A, Nicolosi GL, Rigamonti E, Noonan DM, Lombardo M. Case Report: An Unusual Case of Biventricular Thrombosis in a COVID-19 Patient With Ischemic Dilated Cardiomyopathy: Assessment of Mass Mobility and Embolic Risk by Tissue Doppler Imaging. Front Cardiovasc Med 2021; 8:694542. [PMID: 34395561 PMCID: PMC8358798 DOI: 10.3389/fcvm.2021.694542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein binds to angiotensin-converting enzyme 2 (ACE2) receptor on vascular cells. As a consequence, patients with COVID-19 have an increased incidence of thromboembolic complications of the SARS-CoV-2 infection and subsequent endothelial cell damage with consequence of development of systemic vasculitis and diffuse intravascular coagulation. The present case describes a COVID-19 female patient with ischemic dilated cardiomyopathy, who presented with congestive heart failure and echocardiographic evidence of biventricular apical thrombi. The peak antegrade longitudinal velocity (Va) of each thrombotic mass was measured by pulsed wave tissue Doppler imaging (PW-TDI). Both left ventricular and right ventricular apical thrombi were found with a TDI-derived mass peak Va < 10 cm/s. There was no clinical evidence of neither systemic nor pulmonary embolization, probably due to the hypomobility of both left and right ventricular masses.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
| | - Adriana Albini
- Scientific and Technological Pole, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
| | | | - Elisabetta Rigamonti
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
| | - Douglas M Noonan
- Scientific and Technological Pole, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy.,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Michele Lombardo
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multi Medica, Milan, Italy
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Hu N, Shen W, Li H, Zhang Q, Cai G, Zhang Y, Du G. Right atrial papillary fibroelastoma arising from the Chiari network detected by echocardiography: a case report and literature review. Cardiovasc Pathol 2021; 55:107372. [PMID: 34320368 DOI: 10.1016/j.carpath.2021.107372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/04/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To improve our understanding of cardiac papillary fibroelastoma(PFE)and provide evidence for its treatment and prognosis. MATERIALS AND METHODS We report a 54-year-old Chinese male who was hospitalized for a 14-day headache with a previous vertebral aneurysm history. A right atrial mass arising from the CN was detected by echocardiography and complete tumor resection was performed finally. Pathologic findings confirmed the diagnosis of cardiac papillary fibroelastoma. The recovery of the patient was uneventful and follow-up echocardiographic examination revealed no recurrence of the tumor. RESULTS Transthoracic echocardiography revealed a mobile, sessile mass in the right atrium without obstructing the orifice of the tricuspid valve. The subsequent transesophageal echocardiography confirmed the presence of a 1.56cm × 1.24cm mobile, sessile, irregular mass arising from the CN (Fig. 1) and showed no evidence of patent foramen ovale. CONCLUSIONS Early recognition and surgical excision is essential for patients with cardiac PFE.
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Affiliation(s)
- Nana Hu
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wenqian Shen
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hairu Li
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Qinghua Zhang
- Department of Cardiovascular, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Guohua Cai
- Department of Cardiovascular, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanmei Zhang
- Department of Pathology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Guoqing Du
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Department of Ultrasound, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.
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26
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Abbas E, Al-Hefny E. Brobdingnagian monstrosity at the right heart. Eur Heart J Case Rep 2021; 5:ytab247. [PMID: 34263129 PMCID: PMC8276322 DOI: 10.1093/ehjcr/ytab247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/09/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Eslam Abbas
- Department of OncoCardiology, Dar El Salam Cancer Center, 987 Nile Corniche, Al Kafor, Cairo 11559, Egypt
| | - Ehab Al-Hefny
- Department of Cardiology, Al Azhar University, Cairo 11651, Egypt
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