Pericardial tumor diagnosed by EUS-FNA

Abstract

Because of its high accuracy and safety, EUS-FNA has become a useful tool in the diagnostic and therapeutic management of a wide spectrum of mediastinal diseases. As the heart is located in close proximity to the esophagus, EUS-FNA is feasible as Fritscher-Ravens has reported. Case: A 41-year-old woman with an unremarkable past medical history who presented with a self-limited clinical picture with fever and cough was diagnosed of a pericardial mass after chest film and thoracic MRI were performed. The MRI study displayed a 12 cm mass arising from the left atrio-ventricular angle with areas consisting of necrosis or hemorrhage. The decision to proceed with an EUS-guided FNA was based on the clinical need to obtain tissues to establish an accurate diagnosis and carry out an appropriate management. After informed consent was obtained, the procedure was performed in the endoscopic room with the cardiologist and cardiovascular surgical teams alert. The patient was sedated by an anesthesiologist with propofol without oro-tracheal intubation and prophylactic antibiotic was given intravenously. The EUS displayed a mass arising from the pericardium and, after flushing the working channel with 5 ml of povidone-iodine, a FNA with a 22 gauge needle was performed applying suction with few and gentle to and fro movements. No electrocardiographic changes were observed although a 6 mm hyperechoic lesion at the puncture site suggesting intratumoral bleeding was displayed. The pathologist was on site and informed of the presence of spindle tumoral cells in the cytological smeras and, after 15 minutes watching by EUS the puncuture site, there was no increasing in the size of the probable hematoma and the procedure was finished. There were observed neither arrytmias nor hemodynamic changes in the next 24 hours and the patient was discharged. The final cytologic report was synovial sarcoma and, after a primary lesion was ruled out, surgery was performed with successful resection of the entire tumor, confirming the hystopathologic study of the surgical specimen the findings of the EUS-FNA.