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Marketou ME, Kapsoritakis N, Bourogianni O, Patrianakos A, Kochiadakis G, Plevritaki A, Papadaki S, Zervakis S, Parthenakis F, Koukouraki S. Hybrid imaging of neuroendocrine tumors in the heart: Union is strength. J Nucl Cardiol 2023; 30:298-312. [PMID: 34622428 DOI: 10.1007/s12350-021-02804-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
Cardiac neuroendocrine tumors (NETs) are particularly rare tumors that can lead to a very poor clinical outcome, partly because of metastases but mainly because of manifestations of the hormonal activity they exhibit. Prompt diagnosis is important in order to start the most effective treatment for their removal or management, with the fewest complications. They are often difficult to diagnose, especially in their early stages. One of the reasons for this is that the heart is an organ with a high rate of metabolism and is located in close proximity to other high-metabolism organs. In addition, the anatomic location and their small size render their diagnosis extremely challenging. In recent years, hybrid imaging methods have revolutionized the diagnostic approach to oncology patients and have established a place in the diagnosis of cardiac NETs, because they provide both anatomical and functional information at the same time. Positron emission tomography/computed tomography (PET/CT), PET/magnetic resonance imaging (PET/MRI) and single-photon emission computed tomography/CT (SPECT/CT) are widely used in clinical practice because of the very important metabolic information, the high sensitivity and specificity. However, prospective studies are needed to confirm the true clinical and prognostic value of various hybrid imaging diagnostic techniques in cardiac NETs.
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Affiliation(s)
- Maria E Marketou
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece.
| | - Nikolaos Kapsoritakis
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Olga Bourogianni
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Alexandros Patrianakos
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - George Kochiadakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Anthoula Plevritaki
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Sophia Papadaki
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Stelios Zervakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Fragiskos Parthenakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Sophia Koukouraki
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Quintanilla-Flores DL, Villarreal-Pérez JZ, Vélez-Viveros CA, Portillo-Sánchez P, Ortíz-Morales AJ, González-González JG. Arterial thrombosis and intracardiac thrombus as the initial presentation of a recurrent paraganglioma: case report and review of the literature. Archives of Endocrinology and Metabolism 2021; 65:852-857. [PMID: 33740338 PMCID: PMC10065400 DOI: 10.20945/2359-3997000000342] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pheochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumors that result in the uncontrolled release of catecholamines and secondary hypertension. They usually manifest with episodic blood pressure fluctuations, headaches and palpitations. In some cases PPGLs may be asymptomatic until they are detected as a diagnostic approach to other diseases. There have been reports that have associated PPGLs with arterial thrombosis, some with the additional finding of intracardiac thrombi. We present the case of a 21-year-old male Hispanic patient with a recurrent para-aortic paraganglioma detected by persistent hypertension, bilateral lower limb artery thrombosis and an intracardiac thrombus.
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3
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Yang T, Li Y, Zhang HM, Wang HY, Song YH. Resection of Cardiac Pheochromocytoma With Cardiopulmonary Bypass. Ann Thorac Surg 2020; 111:e153-e155. [PMID: 32828749 DOI: 10.1016/j.athoracsur.2020.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022]
Abstract
We report a case of a 21-year-old man with a cardiac pheochromocytoma involving the right atrium and extending to the right ventricular inflow tract, which was diagnosed by somatostatin receptor scintigraphy. For the preoperative evaluation, we chose multiple methods of imaging to accurately describe the anatomic extent and location of the tumor and its surrounding tissues, which showed that no major coronary artery ran through the tumor. The tumor was resected with disease-free margins effectively and safely with the use of cardiopulmonary bypass and with cardiac arrest. The patient remained asymptomatic at the 3-month follow-up.
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Affiliation(s)
- Tao Yang
- Department of Cardiovascular Surgery, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yuan Li
- Department of Cardiovascular Surgery, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Hui-Min Zhang
- Department of Hypertension, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Hong-Yue Wang
- Department of Pathology, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yun-Hu Song
- Department of Cardiovascular Surgery, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
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4
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Abstract
Cardiac paragangliomas are infrequent tumors. The most common location is in the left atrium. Cardiovascular morbidity and mortality without treatment are high. Different imaging techniques help determine the relation with adjacent structures. Multimodal cardiovascular imaging is an essential tool for diagnosis and therapy.
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Affiliation(s)
- Laura Arcos
- Universidad del Rosario Escuela de Medicina y Ciencias de la Salud, Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
| | - Jorge Bustos
- Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
| | | | | | - Julián Forero
- Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
| | - Claudia Jaimes
- Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
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Chen G, Wang J, Weinberg L, Robinson C, Ho T, Lin W, Gong Z, Liu W, Zhu B, Huang Y. Anaesthetic management of cardiac phaeochromocytoma: A case series. Int J Surg Case Rep 2018; 51:134-138. [PMID: 30153610 PMCID: PMC6110996 DOI: 10.1016/j.ijscr.2018.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/01/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 11/16/2022] Open
Abstract
Primary cardiac phaeochromocytoma is a rare form of catecholamine-secreting heart tumour rarely encountered by anaesthetists. We present a single centre case series of four cardiac phaeochromocytoma surgical excisions. Perioperative management may require aggressive alpha and cautious beta-adrenergic blockage. Intraoperative management requires careful use of vasoactive medications and fluids. We advocate for the use of cardiac pulmonary bypass when excising cardiac phaeochromocytoma.
Introduction Primary cardiac phaeochromocytoma is uncommon, with few anaesthetists encountering this rare pathology in clinical practice. Further, there is little information available on the detailed intraoperative and postoperative haemodynamics and principles of the anaesthetic management of this condition. Presentation of case We present a retrospective, single-centre case series of four patients with cardiac phaeochromocytoma who presented for surgical excision. We describe the perioperative evaluation and management of these patients, consideration of the requirements for cardiopulmonary bypass, and the analgesic and pharmacologic interventions needed to maintain stable perioperative and intraoperative haemodynamics. Discussion Octreotide scintigraphy, in addition to echocardiography, cardiac MRI and coronary angiography proved vital in the preoperative evaluation of these patients. Preoperative anaesthetic management of cardiac phaeochromocytoma involved alpha-adrenergic blockade, judicious beta-adrenergic blockade and hydration. Intraoperatively, the administration of vasodilatory agents prior to, and vasoconstricting agents with volume therapy after tumour excision, were the key elements of anaesthetic management. Furthermore, we believe that cardiopulmonary bypass plays a pertinent role in cardiac phaeochromocytoma excision and that the risks and benefits of pulmonary artery catheters should be considered before use in these patients. Conclusion Management of cardiac phaeochromocytoma is complex and demands careful perioperative planning and management. Perioperative morbidity is common and anaethetists play an important role in achieving a successful outcome for patients who present for excision of cardiac phaeochromocytoma.
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Affiliation(s)
- Guangjun Chen
- Department of Anaesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Jingjie Wang
- Department of Anaesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, 3084, Australia.
| | - Callum Robinson
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, 3084, Australia
| | - Timothy Ho
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, 3084, Australia
| | - Wangjia Lin
- Department of Anaesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyi Gong
- Department of Anaesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Wei Liu
- Department of Anaesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Bo Zhu
- Department of Anaesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yuguang Huang
- Department of Anaesthesiology, Peking Union Medical College Hospital, Beijing, China
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Gurrieri C, Butz JJ, Weingarten TN, Bancos I, Young WF Jr, Cassivi SD, Said SM, McKenzie TJ, Barbara DW, Sprung J. Resection of Intrathoracic Paraganglioma With and Without Cardiopulmonary Bypass. Ann Thorac Surg 2018; 105:1160-7. [PMID: 29452998 DOI: 10.1016/j.athoracsur.2017.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Intrathoracic paragangliomas (PGLs) are rare tumors. Approximately 50% originate from and around cardiac structures. METHODS A retrospective review was made of the perioperative course of patients with intrathoracic PGL resection from 2000 through 2015 at Mayo Clinic in Rochester, Minnesota. RESULTS Twenty-two patients underwent PGL resection. Sixteen patients (73%) had functioning tumors (11, noradrenergic; 4, mixed noradrenergic and dopaminergic; 1, dopaminergic). Patients with functioning tumors received preoperative adrenergic blockade: 15 (68%), α1,2-adrenergic receptor antagonist; 4 (18%), α1-adrenergic receptor antagonists; and 13 (59%) metyrosine. Six patients with nonfunctioning tumors had no adrenergic blockade. Twelve patients had tumor resection without cardiopulmonary bypass-9 for PGL associated with the great vessels, 2 for PGL with pericardial involvement, and 1 for PGL in right atrioventricular groove. Ten patients required cardiopulmonary bypass; for 9, the tumor involved cardiac structures and for 1, it involved ascending aorta and proximal aortic arch. Of these, 1 patient had uncontrollable bleeding and died intraoperatively. Other than this single death, there were no inhospital major cardiac or pulmonary complications. Median follow-up was 8.2 years (range, 2.1 to 17.2). Six patients subsequently had metastatic disease, and of them, 1 died 6 years after the operation. CONCLUSIONS In this series, 73% of intrathoracic PGLs were functional and involved noradrenergic, mixed noradrenergic and dopaminergic, or pure dopaminergic secretion. Cardiac and pericardial paraganglioma resection may require cardiopulmonary bypass. Although intraoperative bleeding in most complex cases may be uncontrollable, as for 1 of our patients, those who survived hospital discharge had favorable long-term outcomes.
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Abstract
Pheochromocytomas are rare endocrine tumors that can have a significant impact on a variety of organ systems, including the cardiovascular system. Although the pathophysiology is not completely understood, pheochromocytomas exert their effects through high levels of catecholamines, mainly epinephrine and norepinephrine, which stimulate adrenergic receptors, including those within the cardiovascular system. Although the most common cardiovascular manifestation is hypertension, patients with pheochromocytoma can present with arrhythmia, hypotension, shock, myocardial ischemia, cardiomyopathy, aortic dissection, and peripheral ischemia. The medical management of the cardiovascular effects of pheochromocytoma is via blockade of adrenergic receptors, usually through the use of alpha blockers, with the addition of beta blockers if needed. However, only surgical resection of the pheochromocytoma is potentially curative, and this tumor requires unique management perioperatively. Because of the variability of presentation and the significant morbidity and mortality of patients with an undiagnosed pheochromocytoma, this entity should not be overlooked in the evaluation of patients with a wide variety of cardiovascular disorders.
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Abstract
Cardiac paragangliomas are extremely rare neoplasms with an incidence of 1% of all cardiac tumors and can be completely asymptomatic, therefore, diagnosis is difficult. This article reports the case of an 18-year-old man with a heart murmur detected during a routine physical examination. Echocardiography revealed a heart tumor measuring 7 cm in size in the right atrium. Due to the tumor size and the threat of tricuspid valve insufficiency, tumor resection was performed. The histopathological examination revealed a cardiac paraganglioma with positive reactions of the tumor cells for chromogranin A, synaptophysin and CD56. Differentiating a primary cardiac paraganglioma from other more common cardiac tumors and particularly from metastases of neuroendocrine neoplasms from other locations is essential not only for the further clinical treatment but also for the prognosis of the patient.
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Zhou X, Liu D, Su L, Long Y, Du W, Miao Q, Li F, Jin Z, Zeng Z, Luo A, Huang Y. Pheochromocytoma crisis with severe cyclic blood pressure fluctuations in a cardiac pheochromocytoma patient successfully resuscitated by extracorporeal membrane oxygenation: a case report. Medicine (Baltimore) 2015; 94:e790. [PMID: 25929929 PMCID: PMC4603056 DOI: 10.1097/md.0000000000000790] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiac pheochromocytoma is relatively rare. Few reports describe the intraoperative and postoperative progression of patients experiencing a life-threatening pheochromocytoma crisis treated with extracorporeal membrane oxygenation (ECMO).A 35-year-old man was referred to our facility for paroxysmal hypertension with a 10-year history of sweating, headaches, cardiac palpitations, and postexercise dyspnea. The patient initially underwent urine catecholamine measurement and an isotope scan, somatostatin receptor scintigraphy, and 18F-fluorodeoxyglucose positron emission tomography/computer tomography (CT), which indicated a multiple, cardiac pheochromocytoma. Echocardiography, cardiac magnetic resonance imaging (MRI), CT reconstruction, and a coronary CT angiography revealed several lesions at the aortic root and along the cardiac vasculature.Multifocal cardiac pheochromocytoma was diagnosed and pheochromocytoma crisis with severe cyclic blood pressure fluctuation occurred during surgery.Surgical resection of multiple pheochromocytomas in the right medial carotid sheath, mediastinum between the main and pulmonary arteries, and between the abdominal aorta and inferior vena artery was performed. To ensure cardiac perfusion and avoid severe circulatory fluctuation, the cardiac paraganglioma resection was prioritized. After resecting the cardiac pheochromocytoma, a severe pheochromocytoma crisis with rapid cyclic blood pressure fluctuation developed. ECMO and intraaortic balloon pump (IABP) were initiated to stabilize circulation and perfusion. Phenoxybenzamine, norepinephrine, epinephrine, and fluid resuscitation were administered to support cardiovascular function.The magnitude of blood pressure fluctuation steadily decreased with treatment. IABP was discontinued after 3 days, and ECMO was discontinued after 16 days. The patient was discharged 3 months postoperatively.This case indicates that mechanical life support with ECMO is a valuable option for pheochromocytoma-induced cardiac shock and should be considered as an effective therapeutic choice in patients with highly unstable hemodynamic function.
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Affiliation(s)
- Xiang Zhou
- From the Department of Critical Care Medicine (XZ, DL, LS, YL, WD); Department of Cardiac Surgery (QM); Department of Nuclear Medicine (FL); Department of Radiology (ZJ); Department of Endocrinology (ZZ); and Department of Anesthesiology (AL, YH), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Rotolo N, Imperatori A, Bacuzzi A, Conti V, Castiglioni M, Dominioni L. Management of hypertension in intrapericardial paraganglioma. Int J Hypertens 2014; 2014:812598. [PMID: 24688789 PMCID: PMC3943413 DOI: 10.1155/2014/812598] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 11/29/2013] [Accepted: 01/07/2014] [Indexed: 12/24/2022] Open
Abstract
Functioning paraganglioma is extra-adrenal catecholamine-secreting tumours that may cause secondary hypertension. Primary intrapericardial paragangliomas are very rare and are located adjacent to the great vessels or heart, typically near the left atrium. These tumours are an exceptionally uncommon finding during the investigation of refractory hypertension. However, in recent years, intrapericardial paragangliomas have been diagnosed incidentally with increased frequency, due to the extensive use of radiologic chest imaging. The mainstay of treatment of functioning intrapericardial paraganglioma is surgical removal, which usually achieves blood pressure normalization. Due to the locations of these tumours, the surgical approach is through a median sternotomy or posterolateral thoracotomy, and manipulation-induced catecholamine release may cause paroxysmal hypertension. Typically in these patients, blood pressure fluctuates dramatically intra- and post-operatively, increasing the risk of cardiovascular complications. We review here the current modalities of perioperative fluid and hypotensive drug administration in the setting of surgery for functioning intrapericardial paraganglioma and discuss the recently proposed paradigm shift that omits preoperative preparation.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, Department of Surgical and Morphological Sciences, University of Insubria, Via Guicciardini 9, 21100 Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Surgical and Morphological Sciences, University of Insubria, Via Guicciardini 9, 21100 Varese, Italy
| | - Alessandro Bacuzzi
- Department of Anaesthesiology, Ospedale di Circolo, Via Guicciardini 9, 21100 Varese, Italy
| | - Valentina Conti
- Center for Thoracic Surgery, Department of Surgical and Morphological Sciences, University of Insubria, Via Guicciardini 9, 21100 Varese, Italy
| | - Massimo Castiglioni
- Center for Thoracic Surgery, Department of Surgical and Morphological Sciences, University of Insubria, Via Guicciardini 9, 21100 Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Surgical and Morphological Sciences, University of Insubria, Via Guicciardini 9, 21100 Varese, Italy
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Ward TJ, Kadoch MA, Jacobi AH, Lopez PP, Salvo JS, Cham MD. Magnetic resonance imaging of benign cardiac masses: a pictorial essay. J Clin Imaging Sci 2013; 3:34. [PMID: 24083071 PMCID: PMC3779397 DOI: 10.4103/2156-7514.117458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 03/25/2013] [Accepted: 08/06/2013] [Indexed: 11/04/2022] Open
Abstract
The differential diagnosis for a cardiac mass includes primary and metastatic neoplasms. While primary cardiac tumors are rare, metastatic disease to the heart is a common finding in cancer patients. Several "tumor-like" processes can mimic a true cardiac neoplasm with accurate diagnosis critical at guiding appropriate management. We present a pictorial essay of the most common benign cardiac masses and "mass-like" lesions with an emphasis on magnetic resonance imaging features.
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Affiliation(s)
- Thomas J Ward
- Department of Radiology, The Mount Sinai Medical Center, New York, NY, USA
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Abstract
We describe the case of 34-year-old woman with a cardiac pheochromocytoma that was diagnosed by scintigraphy using iodine-131 metaiodobenzylguanidine. For preoperative evaluation, we chose multidetector computed tomography instead of coronary angiography, for fear that catheter manipulation might trigger catecholamine release from the tumor; it showed that no major coronary artery branches run through the tumor. The tumor resection was carried out safely with the use of cardiopulmonary bypass and without cardiac arrest.
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Affiliation(s)
- Yuji Kaku
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Satoshi Saito
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hiroyuki Saito
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo, Japan
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González López MT, González SG, García ES, Romero SG, de Loma JG. Surgical excision with left atrial reconstruction of a primary functioning retrocardiac paraganglioma. J Cardiothorac Surg 2013; 8:22. [PMID: 23360571 PMCID: PMC3599281 DOI: 10.1186/1749-8090-8-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 08/01/2012] [Accepted: 01/11/2013] [Indexed: 01/27/2023] Open
Abstract
About 2% of all paragangliomas are located in the chest, and a few have been described to be found in the heart. Primary cardiac paragangliomas are extremely uncommon tumors and surgical experience with this neoplasm is limited. Treatment strategies described in the literature have included simple excision, excision with reconstruction, autotransplantation after excision of the tumor and even orthotopic cardiac transplantation, depending on the extent of disease. A primary retrocardiac paraganglioma catecholamine-productive was identified in an asymptomatic 49–year old female associated to familial pheochromocytoma-paraganglioma syndrome caused by germline mutation of the gen which codifies for the subunit B of succinate dehydrogenase enzyme (SDHB). The neoplasm was surgically excised from the posterior surface of the left atrium via median sternotomy using cardiopulmonary bypass. Direct ligation of feeding vessels of the tumor along with left atrial reinforcement using a pericardial patch was performed. The post-operative course was uneventful, with normalization of catecholamine secretion and no recurrence at three-month follow-up. We review the current literature about this exceptional cardiac tumor, pathophysiological conditions and options for surgical management.
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Affiliation(s)
- María Teresa González López
- Cardiovascular Surgery Department, Carlos Haya Regional Hospital, Carlos Haya Avenue, s/n, 29010 Málaga, Spain.
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15
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Abstract
Cardiac neoplasms and other mass-forming lesions are not commonly encountered in surgical pathology practice. Fortunately, for the most part, these fall into a small group of well characterized and readily-recognized entities, although they are not without diagnostic dilemmas. A brief and practical synopsis of cardiac tumors is presented in this section with attention to more frequently encountered and clinically significant diagnostic challenges as well as pertinent clinical associations and prognostic information.
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Affiliation(s)
- Dylan V Miller
- Intermountain Central Laboratory, Immunostains and Electron Microscopy, University of Utah, 5252 South Intermountain Drive, Salt Lake City, UT 84157, USA
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16
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Abstract
Clinical expression of phaeochromocytoma may involve numerous cardiovascular manifestations, but usually presents as sustained or paroxysmal hypertension associated with other signs and symptoms of catecholamine excess. Most of the life-threatening cardiovascular manifestations of phaeochromocytoma, such as hypertensive emergencies, result from a rapid and massive release of catecholamines from the tumour. More rarely, patients with phaeochromocytoma present with low blood pressure or even shock that may then precede multisystem crisis. Sinus tachycardia, with palpitations as the presenting symptom, is the most prevalent abnormality of cardiac rhythm in phaeochromocytoma, but tumours can also be associated with more serious ventricular arrhythmias or conduction disturbances. Reversible dilated or hypertrophic cardiomyopathy are well established cardiac manifestations of phaeochromocytoma, with more recent attention to an increasing number of cases with Takotsubo cardiomyopathy. This review provides an update on the cause, clinical presentation and treatment of the cardiovascular manifestations of phaeochromocytoma. As the cardiovascular complications of phaeochromocytoma can be life-threatening, all patients who present with manifestations that even remotely suggest excessive catecholamine secretion should be screened for the disease.
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17
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Li L, Zhu W, Fang L, Zeng Z, Miao Q, Zhang C, Fang Q. Transthoracic echocardiographic features of cardiac pheochromocytoma: a single-institution experience. Echocardiography 2011; 29:153-7. [PMID: 22066682 DOI: 10.1111/j.1540-8175.2011.01556.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cardiac pheochromocytoma is extremely rare. Previous papers usually are reports of a single case. Transthoracic echocardiography (TTE) offers a useful option, but the features of cardiac pheochromocytoma on TTE have not been favorably reported. In this study, the findings of cardiac pheochromocytoma on TTE in nine cases were presented. METHODS TTE images (especially two-dimensional ultrasound) of nine patients with cardiac pheochromocytomas were analyzed retrospectively and compared with the findings from surgery. RESULTS Among the nine patients with cardiac pheochromocytomas identified in Peking Union Medical College Hospital (PUMCH) clinical and echocardiographic database, TTE identified one cardiac tumor in seven cases (77.8%), two cardiac tumors in one case (11.1%), and a false-negative result in another (11.1%). Cardiac pheochromocytomas were usually located on the base of the heart, near the origin of great arteries. The tumors were usually round or ovoid, ranging from 1.4 cm to 7.7 cm in diameter, with homogeneous and moderate echoes and low activity. They could press or invade surrounding cardiac structures and influence hemodynamics. In this study the majority of cardiac pheochromocytoma seemed marginated and appeared to be encapsulated on TTE. Apical four-chamber view and parasternal short-axis view of the aortic valve were most effective in identifying cardiac pheochromocytomas. The findings on TTE were similar to those from surgical procedures. CONCLUSION Cardiac pheochromocytomas presented characteristic TTE appearances in aspect of location, size, texture, and shape of tumors. Understanding of these characteristics on TTE can help correctly recognize this extremely rare disease.
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Affiliation(s)
- Ling Li
- Department of Cardiology, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Hou R, Leathersich AM, Ruud BT. Pheochromocytoma presenting with arterial and intracardiac thrombus in a 47-year-old woman: a case report. J Med Case Rep 2011; 5:310. [PMID: 21752274 PMCID: PMC3152527 DOI: 10.1186/1752-1947-5-310] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 05/25/2010] [Accepted: 07/13/2011] [Indexed: 11/30/2022] Open
Abstract
Introduction Pheochromocytoma is a rare cause of hypertension but it could have severe consequences if not recognized and treated appropriately. The association of pheochromocytoma and thrombosis is even rarer but significantly increases management complexity, morbidity and mortality. To the best of our knowledge, this is the first report of a patient with pheochromocytoma presenting with left axillary arterial and intracardiac thrombus. Case presentation A 47-year-old Caucasian woman with a past medical history of hypertension presented for medical attention with left arm numbness. Doppler ultrasound showed an obstructing thrombus in her left axillary artery. She had symptom resolution after stent placement in her left axillary artery. A subsequent echocardiogram demonstrated a large intracardiac mass and abdominal computed tomography revealed a 7 cm mass between her spleen and left kidney. Labile blood pressure was noted during admission and she had very high levels of plasma and 24-hour urine catecholamines and metanephrines tests. A (123)I- metaiodobenzylguanidine scan showed intense uptake in the left abdominal mass. After adequate alpha blockage with phenoxybenzamine, laparoscopic tumor resection was performed without complications. She had normal metanephrines and complete symptom resolution afterwards. The intracardiac mass also disappeared with anticoagulation. All other endocrine laboratory abnormalities returned to normal after surgery. Conclusion Arterial and ventricular thrombosis occurring in patients with pheochromocytoma is rare. A multi-disciplinary approach is necessary in caring for this type of patient. Catecholamines likely contributed to the development of thrombosis in our patient. Early recognition of pheochromocytoma is the key to improving outcome.
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Affiliation(s)
- Runhua Hou
- Endocrine Unit, Department of Medicine, University of Rochester, Rochester, NY, 14642, USA.
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Moskovitch G, Chabbert V, Escourrou G, Desloques L, Otal P, Glock Y, Rousseau H. Tumeurs cardiaques : aspects en scanner et en IRM. ACTA ACUST UNITED AC 2010; 91:857-77. [DOI: 10.1016/s0221-0363(10)70128-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bamous M, Henaine R, Wautot F, Ngola J, Lantelme P, Ninet J. Resection of Secreting Cardiac Pheochromocytoma With and Without Cardiopulmonary Bypass. Ann Thorac Surg 2010; 90:e1-3. [DOI: 10.1016/j.athoracsur.2010.03.095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 03/02/2010] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
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Jain D, Maleszewski JJ, Halushka MK. Benign cardiac tumors and tumorlike conditions. Ann Diagn Pathol 2010; 14:215-30. [DOI: 10.1016/j.anndiagpath.2009.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
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Tomasian A, Lai C, Ruehm S, Krishnam MS. Cardiovascular magnetic resonance and PET-CT of left atrial paraganglioma. J Cardiovasc Magn Reson 2010; 12:1. [PMID: 20047692 PMCID: PMC2817869 DOI: 10.1186/1532-429x-12-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 01/04/2010] [Indexed: 11/30/2022] Open
Abstract
Cardiac paragangliomas are among the rarest primary cardiac tumors. We present a case of left atrial paraganglioma in a patient who presented with symptoms and signs of catecholamine excess in which cardiovascular magnetic resonance in multiple orientations and PET-CT played an important role in the diagnosis and tissue characterization.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiological Sciences, University of California at Los Angeles, USA
| | - Chi Lai
- Department of Pathology, University of California at Los Angeles, USA
| | - Stefan Ruehm
- Department of Radiological Sciences, University of California at Los Angeles, USA
| | - Mayil S Krishnam
- Department of Radiological Sciences, University of California at Los Angeles, USA
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Lorusso R, De Cicco G, Tironi A, Gelsomino S, De Geest R. Giant primary paraganglioma of the left ventricle. J Thorac Cardiovasc Surg 2009; 137:499-500. [DOI: 10.1016/j.jtcvs.2008.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 02/22/2008] [Accepted: 03/02/2008] [Indexed: 11/26/2022]
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Khalid TJ, Zuberi O, Zuberi L, Khalid I. A rare case of cardiac paraganglioma presenting as anginal pain: a case report. Cases J 2009; 2:72. [PMID: 19159442 PMCID: PMC2635122 DOI: 10.1186/1757-1626-2-72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 01/21/2009] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Primary cardiac paraganglioma is a very rare tumor with less than sixty reported cases in the literature. The clinical presentation is variable, but is most commonly manifested by hypertension and symptoms related to the catecholamine excess. CASE REPORT We report a case of a 35 year old man who presented with anginal pain and hypertension. He was found to have a cardiac mass on the computed tomographic scan and echocardiogram. He underwent surgical exploration of the mass which on biopsy was found to be a 'Cardiac Paraganglioma'. Surgical resection of the tumor was successfully done and the patient is doing well five years after the surgery without any evidence of recurrence. His blood pressure, however, failed to normalize and needed single agent antihypertensive therapy. CONCLUSION Cardiac paragangliomas have a relatively favorable outcome if diagnosed and resected in time. We briefly review the literature regarding the diagnosis, treatment and prognosis of this rare tumor.
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Abstract
We present the case of a 61-year-old man who underwent I-123 metaiodobenzylguanidine (MIBG) scintigraphy based on clinical suspicion of pheochromocytoma. The study was nondiagnostic secondary to diffuse muscle uptake. On review of his medications, the patient was found to be taking mirtazapine, a tetracyclic antidepressant (Remeron). We hypothesize that the MIBG biodistribution was altered by mirtazapine-mediated blockade of the presynaptic alpha-2 receptor. To our knowledge, tetracyclic antidepressants have not been previously reported to cause altered biodistribution on I-123 MIBG scans.
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26
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Abstract
Mediastinal pheochromocytomas account for only a small fraction of mediastinal tumors. Most commonly, these tumors are located in posterior mediastinum. Increasing number of cases of pheochromocytomas is being reported from middle mediastinum. Excision of mediastinal paraganglioma is often hazardous because of its rich blood supply and tendency to involve surrounding structures. It can be a big challenge to manage asymptomatic cases of pheochromocytoma intraoperatively. It is imperative that these patients receive adequate alpha adrenergic and if necessary beta adrenergic blockade. Adequate preoperative preparation with alpha and beta blockers may not prevent serious intraoperative hypertension. We report a case of posterior mediastinal pheochromocytoma which was biochemically active preoperatively. We review the presentation, diagnosis and management of intrathoracic pheochromocytomas including cardiac pheochromocytomas.
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Affiliation(s)
- Jaswinder Singh
- Department of Cardiovascular and Thoracic Surgery, Military Hospital (Cardiothoracic Centre), Golibar Maidan, Pune, India.
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27
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Kojima Y, Kitahara H, Kimura H, Nakamura T, Ina H, Yokota S. Anesthetic management of simultaneous coronary artery bypass grafting and cardiac pheochromocytoma resection under cardiopulmonary bypass. J Anesth 2007; 21:504-6. [DOI: 10.1007/s00540-007-0549-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 06/29/2007] [Indexed: 10/22/2022]
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28
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Yuan WQ, Wang WQ, Su TW, Chen HT, Shi ZW, Fang WQ, Li B, Jin XL, Zang WF, Ning G. A primary right atrium paraganglioma in a 15-year-old patient. Endocrine 2007; 32:245-8. [PMID: 18041591 DOI: 10.1007/s12020-007-9019-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 10/21/2007] [Accepted: 10/29/2007] [Indexed: 12/01/2022]
Abstract
Thoracic pheochromocytomas account for less than 2% of reported cases, while primary cardiac paragangliomas are even rare. The following case illustrates a 15-year-old patient with primary right atrium paraganglioma. This patient was referred for paroxysmal hypertension and excessive perspiration. Pheochromocytoma was suspected and then confirmed by very high serum nor-metanephrine which increased more than 30-fold above the upper limit of normal. 131I-metaiodobenzylguanidine (MIBG) scintigraphy showed high uptake only in the middle mediastinum, but not in the adrenal glands or elsewhere. Both contrast CT and gated MRI of the chest disclosed a 5.0 x 4.0 cm2 mass in the right atrium. Coronary angiography demonstrated the mass with feeding vessels from the right coronary artery. When the patient's blood pressure was well controlled with doxazosin and metoprolol, surgery was then performed. A 6.0 x 4.9 x 4.0 cm3 round solid right atrium paraganglioma weighing 41.7 g was resected. The second day after surgery, serum nor-metanephrine and urinary noradrenaline levels dropped rapidly to normal range, and the patient was free of clinical symptoms with normal BP. Postoperative cardiac function, as measured by echocardiogram, was normal. Although cardiac paraganglioma may be difficult to resect, it can be cured.
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Affiliation(s)
- Wen-Qi Yuan
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, 197 Ruijin Er Lu, Shanghai, 200025, PR China
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29
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Abstract
The majority of primary cardiac tumors are benign; of these tumors, cardiac paragangliomas are among the rarest. We report a case of biatrial cardiac paraganglioma discovered during workup for palpitations and fatigue. The tumor involved the interatrial septum, with a lobulated portion protruding through the foramen ovale into the right atrium. The tumor was successfully excised, leading to uneventful recovery.
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Affiliation(s)
- Thomas S Maxey
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA 30322, USA.
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30
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Hayek ER, Hughes MM, Speakman ED, Miller HJ, Stocker PJ. Cardiac Paraganglioma Presenting With Acute Myocardial Infarction and Stroke. Ann Thorac Surg 2007; 83:1882-4. [PMID: 17462425 DOI: 10.1016/j.athoracsur.2006.12.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 10/30/2006] [Accepted: 12/06/2006] [Indexed: 11/25/2022]
Abstract
We report an unusual presentation of cardiac paraganglioma with acute myocardial infarction and stroke induced by exercise and review the literature regarding this rare cardiac tumor.
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Affiliation(s)
- Emil R Hayek
- Department of Cardiology, Akron General Medical Center, Akron, Ohio 44307, USA.
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31
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Abstract
Primary pheochromocytomas of the heart are extremely rare tumors and difficult to diagnose. Iodine labeled metaiodobenzylguanidine (MIBG) is the first choice of the nuclear medicine modality in the evaluation of adrenal pheochromocytoma. However, the sensitivity of MIBG in the diagnosis of extraadrenal pheochromocytoma is less optimal. In this preliminary report, the efficacy of octreotide scintigraphy using Tc-99m labeled hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC) in the evaluation of primary cardiac pheochromocytoma was assessed.
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Affiliation(s)
- Libo Chen
- Department of Nuclear Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Beijing, P.R. of China
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32
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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34
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Affiliation(s)
- Gustavo Knop
- Department of Cardiovascular Surgery, Argentina Clinic, General Pico, La Pampa, Argentina.
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35
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Abstract
Tragically as many as 50% of pheochromocytomas are discovered at autopsy, mainly because the diagnosis of this neuroendocrine tumor was not considered. Missing the diagnosis almost invariably results in devastating cardiovascular complications or death. Clinicians must always think of pheochromocytoma whenever evaluating a patient with sustained or paroxysmal hypertension or any manifestations suggesting hypercatecholaminemia. Very rarely, familial pheochromocytomas may cause no hypertension, symptoms, or signs. But biochemical testing can always establish the presence or absence of a pheochromocytoma, and localization with magnetic resonance imaging, computed tomography, or 131I or 123I-MIBG is almost always possible.
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Affiliation(s)
- William M Manger
- National Hypertension Association, 324 East 30th Street, New York, NY 10016, USA.
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36
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Affiliation(s)
- Eric J Okum
- Division of Cardiothoracic Surgery, Virginia Commonwealth University Medical Center, Richmond 23298-0068, USA
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37
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Abstract
Phaeochromocytomas of the heart are very rare. This report describes the case of a 69 year old woman presenting with persistent hypertension and a left atrial phaeochromocytoma diagnosed by 131I-metaiodobenzylguanidine scintigraphy scanning. She was successfully treated by surgical excision with the aid of cardiopulmonary bypass and perioperative alpha and beta adrenergic blockade.
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Affiliation(s)
- N Moorjani
- Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth PL6 8DH, UK.
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38
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Abstract
Pheochromocytoma is a rare but extremely treacherous neuroendocrine tumor causing manifestations by secreting catecholamines into the circulation. It is usually fatal if unrecognized. Manifestations can mimic many diseases and cause erroneous diagnoses. Approximately 15% are malignant, 18% extra-adrenal, and 20% familial. Plasma or urinary metanephrines are approximately 98% sensitive for detecting pheochromocytomas. They can be localized by MRI and CT; (131)I- and (123)I-metaiodobenzylguanidine (MIBG) are highly specific and 81% to 90% sensitive, respectively. Suspect pheochromocytoma in patients with sustained or paroxysmal hypertension or in normotensives having manifestations of hypercatecholaminemia. Surgical removal is usually curative; chemotherapy and radiotherapy are palliative for malignant pheochromocytomas.
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Affiliation(s)
- William M Manger
- New York University Medical Center and National Hypertension Association, 324 East 30th Street, New York, NY 10016, USA. nathypertension@aol
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39
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Affiliation(s)
- Ju-Mei Ng
- Department of Anaesthesia & Surgical Intensive Care, Singapore General Hospital, Singapore, Singapore.
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40
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Abstract
Pheochromocytoma is a catecholamine-producing tumor and a rare cause of hypertension. Most cases are intra-adrenal and intrapericardial pheochromocytomas are extremely uncommon. We report the case of a 46-year-old woman with a 1-year history of hypertension, in which a right atrial pheochromocytoma was detected after a hypertensive crisis. 131I-metaiodobenzylguanidine scintigraphy and magnetic resonance imaging established the diagnosis. The tumor was successfully resected using cardiopulmonary bypass and the right atrium was reconstructed using bovine pericardium.
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Affiliation(s)
- Rubén A Cabo
- Departamento de Cirugía Cardiovascular. Clínica Puerta de Hierro. Madrid. España
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41
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Affiliation(s)
- Martin Osranek
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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42
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43
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Affiliation(s)
- Irwin E Brown
- Departments of Anesthesiology and Cardiovascular Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA
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44
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Affiliation(s)
- Stephanie W Heindel
- Department of Anesthesia, Division of Cardiac Anesthesia, Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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45
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Abstract
Pheochromocytoma, a relatively rare (<0.05% of hypertensives), catecholamine-secreting tumor, is almost always lethal unless recognized and appropriately treated. Clinical and biochemical manifestations are mainly caused by excess circulating catecholamines and hypertension. Manifestations mimic many conditions, which may result in erroneous diagnoses and improper treatment. Sustained or paroxysmal hypertension associated with headaches, sweating, or palpitations, occurs in 95% of patients, but at least 5% are normotensive. All patients with manifestations of hypercatecholaminemia or coexisting neoplasms should be investigated for pheochromocytoma. Plasma free metanephrines and fractionated urinary metanephrines are the most sensitive (about 100%) chemical tests for diagnosing sporadic and familial pheochromocytomas; plasma and urinary catecholamines and total metanephrines are fairly sensitive for identifying sporadic cases but are less sensitive for familial tumors. The clonidine suppression test helps exclude other conditions that may elevate plasma and urinary catecholamines and their metabolites. Magnetic resonance imaging is more sensitive than computed tomography for localizing pheochromocytomas; iodine-131-metaiodobenzylguanidine (131I-MIBG) tumor uptake confers specificity. Surgical resection is successful in 90% of cases, but 10% of tumors are malignant. Pheochromocytomas <5 cm in diameter can be removed laparoscopically; larger tumors should be removed by open surgery. Drug treatment prior to and during surgery is mandatory; drug treatment, chemotherapy, and radiation therapy are used to treat malignant lesions.
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Affiliation(s)
- William M Manger
- Department of Medicine, National Hypertension Association, 324 East 30th Street, New York, NY 10016, USA
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46
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Abstract
Cardiac phaeochromocytoma is a rare cause of endocrine hypertension. We report a case of a 25-year-old woman, who presented with severe hypertension and intermittent chest pain. The patient denied typical phaeochromocytoma spells of palpitation, headache, and diaphoresis. The 24-hr urinary excretion of norepinephrine was increased sevenfold above the upper limit of normal; however, the excretion of total metanephrines, epinephrine, and dopamine were normal. Computed tomography (CT) scan of the abdomen was normal. An 131I-labelled metaiodobenzylguanidine (MIBG) scan was falsely negative while the patient was taking labetalol. The cardiac phaeochromocytoma was localized with indium-111-pentetreotide scintigraphy and chest magnetic resonance imaging scan. Repeat 123I-MIBG scintigraphy was positive after discontinuing labetalol. The cardiac phaeochromocytoma was located in the right atrial groove, adjacent to the tricuspid valve, and contained multiple feeder arteries from the right coronary artery. After treatment with volume expansion, alpha-methyl-p-tyrosine, and alpha- and beta-adrenergic blockade, surgical resection was performed. While under cardiopulmonary bypass, coronary bypass grafting and tricuspid annuloplasty were performed to facilitate the complete surgical resection of the 4.5-cm tumour. The surgical course was uncomplicated, with complete cure of hypertension and normalization of catecholamine excretion. Post-operative cardiac function, as measured by echocardiogram, was normal. Although cardiac phaeochromocytoma may be highly vascular, invasive and difficult to resect, it can be cured.
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Affiliation(s)
- A M Sawka
- Division of Endocrinology, Metabolism and Nutrition, Internal Medicine, Mayo Clinic, Mayo Foundation, Rochester, MN 55905, USA
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47
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Abstract
Primary pheochromocytomas of the heart are extremely uncommon. In this report, we present the case of a patient with primary cardiac pheochromocytoma arising from the interatrial septum. Metaiodobenzylguanidine-scintigraphy was negative and diagnosis was confirmed by a positive octreotide scintiscan. The tumor was removed successfully using cardiopulmonary bypass.
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Affiliation(s)
- J P Meunier
- Service de Chirurgie Cardio-Vasculaire, H pital du Bocage, Centre Hospitalier-Universitaire de Dijon, France.
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48
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Abstract
This is a presentation of a unique case of cardiac pheochromocytoma during pregnancy. The case is significant because pheochromocytoma is a difficult diagnosis and its rarity during pregnancy may lead to this important diagnosis being overlooked, even though treatment is specific and highly successful.
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Affiliation(s)
- T G Pickering
- Department of Medicine, Joan and Sanford I. Weill Medical College, New York Presbyterian Hospital, New York, USA
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49
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Abstract
Thoracic paragangliomas are a rare cause of hypertension. We report the occurrence of a sporadic benign norepinephrine-producing branchiomeric paraganglioma in a 32-year-old man with paroxysms of hypertension. After localization by iodine 123-metaiodobenzyl-guanidine scintigraphy and magnetic resonance imaging, the paraganglioma was resected successfully below the right pulmonary artery through a right-sided posterolateral thoracotomy. The particular location was consistent with a branchiomeric paraganglioma in an extremely rare extrapulmonary location.
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Affiliation(s)
- B Szukics
- Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
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50
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Abstract
Benign primary cardiac neoplasms are rare but may cause significant morbidity and mortality. However, they are usually treatable and can often be diagnosed with echocardiography, computed tomography (CT), or magnetic resonance (MR) imaging. Myxomas typically arise from the interatrial septum from a narrow base of attachment. Fibroelastomas are easily detected at echocardiography as small, mobile masses attached to valves by a short pedicle. Cardiac fibromas manifest as a large, noncontractile, solid mass in a ventricular wall at echocardiography and as a homogeneous mass with soft-tissue attenuation at CT. They are usually homogeneous and hypointense on T2-weighted MR images and isointense relative to muscle on T1-weighted images. Paragangliomas usually appear as large, echogenic left atrial masses at echocardiography and as circumscribed, heterogeneous masses with low attenuation at CT. These tumors are usually markedly hyperintense on T2-weighted MR images and iso- or hypointense relative to myocardium on T1-weighted images. Cardiac lipomas manifest at CT as homogeneous, low-attenuation masses in a cardiac chamber or in the pericardial space and demonstrate homogeneous increased signal intensity that decreases with fat-saturated sequences at T1-weighted MR imaging. Cardiac lymphangiomas manifest as cystic masses at echocardiography and typically demonstrate increased signal intensity at T1- and T2-weighted MR imaging. Familiarity with these imaging features and with the relative effectiveness of these modalities is essential for prompt diagnosis and effective treatment.
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Affiliation(s)
- P A Araoz
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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