Cardiac benign tumors: echocardiography and computed tomography findings in two cases with histopathologic correlation

Abstract

The aim of this study is to present two patients with cardiac tumors, which by their localization, size and histopathological lineage, can be considered very rare. The clinical, echocardiographic, computed tomography and pathological findings obtained in two examples were analyzed. The first case was a 54-year-old female who had progressive dyspnea with small efforts and presyncope of 1 month of evolution, most likely related to obstructive tricuspid valve myxoma-generated process, which protruded into the right ventricle reaching the apex, as was demonstrated in bidimensional color Doppler and tridimensional echocardiography. The second case was a 66-year-old male with a 6-month history of fatigue, weakness and dyspnea with great effort. The echocardiogram showed an heterogeneous ovoid mass in the right ventricle, attached to the interventricular septum with tricuspid septal leaflet infiltration. The cardiac computed tomography (CT) corroborated the presence of tumor with calcification and fat components, suggestive of teratoma, because mature cartilage tissue is not always identifiable with CT and Hounsfield units of cartilages are variable. The calcium density on the CT image is considered to be bone or cartilage, but is not specific. The differential diagnosis with liposarcoma is described in discussion. Two-dimensional echocardiography is the primary diagnostic imaging modality in the morphological evaluation of intracardiac masses, it is also useful in the following-up of the possible recurrences. This technique is non-invasive, low cost and provides real-time imaging with high spatial and temporal resolution. Three-dimensional echocardiography is a useful tool that provides additional information and better morphological characterization of intracardiac masses. Computed tomography can accurately identify the components of the tumor and it contributed to the proper diagnosis of teratoma. In both patients, the diagnosis was early and precise, with surgical curative resection of the tumors and good prognoses.