Blood Cysts Research Articles

Mitral valve leaflet blood cyst treated with minimally invasive approach: a case report and review of literature

IntroductionCardiac blood cyst is a very rare benign tumor of the heart in adults. Though it is very common in the first half year of life, it regresses with time and its occurrence is very rare in children older than six months and in adults. Until now less than 100 valvular blood cyst cases have been reported in adults.Case presentationWe present a case of a 66-year-old male who presented to us with exertional chest tightness, shortness of breath, and right leg weakness for two weeks. He was diagnosed with a cardiac mass two months ago in another hospital. The physical examination was unremarkable. Abdominal ultrasound showed a cyst in the liver and left kidney. Echocardiography showed a mass-occupying lesion of a cystic nature in the mitral valve with moderate mitral regurgitation. Based on echocardiography findings and computed tomography report, the preliminary diagnosis of mitral valve cystic tumor was made. The patient underwent minimally invasive resection of the cyst. The posterior mitral cusp was repaired and a mitral annuloplasty ring was placed. The postoperative recovery was uneventful. The histopathology report confirmed the diagnosis of a cardiac blood cyst. The patient was followed up for six months without any complications. This case is presented to enrich the medical literature on the cardiac blood cyst.ConclusionAlthough a cardiac blood cyst is a rare entity in adults, it still should be considered in the differential diagnosis of cardiac tumors. Because the natural history and hemodynamic effects are very diverse, large symptomatic cardiac blood cysts, especially in the left heart should be resected to avoid complications.

Emoji-like structure in the right atrium: identified as blood cyst and removed by interventional venous drainage cannula.

Intracardiac blood cysts are thin-walled, blood-filled and round-shaped malformations, commonly located to the endocardium of semilunar or atrioventricular valves. Blood cysts with a diameter of a few millimetres are a frequent finding in neonates and infants 2 years of age or younger,1 but in adults they are rare. On echocardiography, blood cysts have usually a round or oval shape, about the half are pedunculated or mobile, their size varies in adults, but cysts up to a diameter of 40 mm have been reported, and usually the trapped blood within the cyst appears echo-free.2,3 The aetiology of acquired blood cysts in adults remains unknown. Furthermore, the management of adult patients with a blood cyst is controversial. We present a 56-year-old male patient in whom a mobile blood cyst in the right atrium was found by transesophageal echocardiography as part of preoperative diagnostic investigation in pocket infection of a cardiac contractility modulation device. The patient had a history with multiple lead implantations since 28 years due to AV block and dilatative cardiomyopathy. The blood cyst has been successfully removed by a venous drainage cannula (AngioVac system). In this case, the evolution of blood cyst is compatible with a possible mechanical injury of endocardium due to multiple insertions and high number of leads in the right heart. To the best of our knowledge, here we report for the first time on the removal of a blood cyst using a large venous drainage cannula (22 french size).

Tricuspid Valve Blood Cysts Mimicking Thrombus or Vegetation on Echocardiogram in a Neonate.

A 2-month-old male infant, born premature with a birth weight of 865g, was found to have a tricuspid valve mass mimicking thrombus and vegetation by echocardiogram on the fourth day of life. The patient was treated with antibiotics and anticoagulation with no change in the size of the mass on serial follow-up echocardiography. The patient died of severe pulmonary vein stenosis and complex neurological disability. Postmortem cardiac examination revealed numerous cardiac blood cysts with two dominant ones (1.6 and 1.5mm) on the septal leaflet of the tricuspid valve, which based on the location and position corresponded to the suspected vegetation and thrombus on imaging. Cardiac blood cysts on valve leaflets are a common incidental finding during autopsy within the first 6months of life; however, they are rarely detected on imaging because of their minute size, often < 0.5mm. In this case, the sizable blood cysts were thought to represent thrombus or vegetation on echocardiogram, which influenced the patient management.

Mucosal associated Lymphoid Tissue Lymphoma of the uvea: an analysis of 3 cases

BackgroundOcular mucosa-associated lymphoid tissue (MALT) lymphoma involving orbit and conjunctiva usually has an indolent clinical course with “salmon patch” mass as typical presentation. This study is to report a series of rare cases and investigate the clinical and pathological features of ocular MALT lymphoma that involved uveal tissue primarily and presented as posterior scleritis.MethodsThis retrospective, observational study was conducted at Beijing Tongren Hospital. From 2018 to 2020, 3 cases of 3 eyes (2 female patients and 1 male patient) with ocular MALT lymphoma that involved uveal tissue primarily and presented as posterior scleritis were included in the study. All patients had complaints of red eyes with blurred vision. The average age was 56.33 ± 2.08 years old and the average time from initial diagnosis to pathological diagnosis was 3.00 ± 1.73 months. Ophthalmic examinations including best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp microscope examinations, fundus photography, B-scan ultrasonography, ultrasound biomicroscope (UBM), optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were conducted. Systemic workups including orbital magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) and blood autoimmune antibody tests were also conducted. Pathological tissue from patients were obtained through surgeries. Biopsy examinations were performed to accurately determine pathological diagnosis. All the information of clinical, imaging and pathological changes were collected and analyzed.ResultsAt the initial diagnosis, the BCVA of involved eyes decreased seriously while the IOP were normal. All involved eyeball showed extensive hyperemia and local thickening in the wall of eyeballs. B-scan ultrasonography showed mass with abundant blood and irregular cysts inside the eyeball wall and in the retrobulbar orbit, surrounding the ocular wall and optic nerve. UBM showed solid lesions with low and medium echo under the conjunctiva and inside the ciliary body of 2 cases. OCT showed posterior polar wavy rise of RPE and local neuroepithelial detachment in all cases. FFA and ICGA showed vascular abnormalities (patch-like strong fluorescence and fluorescence leakage) and local thickening in retina and choroid (Rectangle-like weak fluorescence below the macula). The posterior wall of the eyeball was thickened and enhanced in MRI. PET-CT also showed thickening of posterior wall of eyeballs and increased metabolic activity but there was no sign of autoimmune disease. All patients were diagnosed as MALT lymphoma through pathologic examinations of biopsy tissue.ConclusionsThe onset of primary ocular MALT lymphoma in uvea is hidden. The early clinical manifestations are lack of specificity and misleading. B-scan ultrasonography has characteristic manifestations and is valuable in diagnosis. However, pathological diagnosis through tissue biopsy is irreplaceable.

P105 A MARBLE IN THE HEART: A MYSTERIOUS MITRAL MASS

Abstract A 70–year–old woman came to our observation for acute heart failure during atrial fibrillation with high ventricular response. In the medical history she presented a previous radiofrequency ablation of paroxysmal supraventricular tachycardia, a previous episode of atrial fibrillation treated with electrical cardioversion, two hospitalizations for transient ischemic attack (TIA), the last two months before hospitalization . The patient had always refused the introduction of oral anticoagulant therapy. The transthoracic echocardiogram showed a rounded formation, with regular margins, of 20x19 mm, isoechoic and poorly mobile, adhered to the atrial side of the annulus and the posterior mitral flap, confirmed by the transesophageal echocardiogram (Fig 1,2,3). The formation did not result in mitral obstruction or significant mitral regurgitation. The left atrium appeared markedly dilated, with moderate spontaneous echo inside. In the left appendage there was no thrombus, and there were no other relevant findings. Markers of inflammation and serial blood cultures taken during hospitalization were negative, so bacterial endocarditis appeared unlikely. Mixoma or fibroelastoma appeared to be the most likely diagnosis. In consideration of the high risk of embolization and to clarify the diagnosis, the patient underwent cardiac surgery with exeresis of the formation (Fig 4–5), subsequent quadrangular resection of the posterior mitral flap, sliding and mitral annuloplasty. Macroscopically, the mass appeared brownish–red, with a smooth surface, solid and compact consistency. The histological analysis showed red blood cells and platelets mixed with vessels and granulation tissue; the wall of the mass was made up of connective tissue. Based on the findings, the differential diagnosis was between a blood cyst or a native mitral valve thrombosis. Blood cysts are generally congenital and disappear spontaneously in childhood, rarely occurring in adults. They are fluid or semi–fluid formations, and ultrasonographically they appear as masses with anechoic or hypoechoic content, surrounded by a thin wall. Thrombosis on native mitral valve is also an infrequent event, but described in literature, particularly in the presence of hypercoagulative states, mitral stenosis, atrial fibrillation. Based on the characteristics of the mass, we believe that the most likely hypothesis is that of a rare case of thrombosis on a native mitral valve.

Clinical and echocardiographic characteristics of cardiac blood cysts

BackgroundCardiac blood cysts (BCs) are rare benign cardiac masses. This study aimed to summarize the clinical and echocardiographic characteristics and clinical outcomes of patients with BCs. MethodsThis retrospective study enrolled patients diagnosed with BC between 2009 and 2021 at a single center in China. Their clinical and echocardiographic characteristics, management, and outcomes at follow-up are summarized. ResultsThe study population comprised 26 patients with BCs with a mean age of 40 ± 19 years (median, 42 years; range, 27–56 years). The cohort was predominantly male (16, 62%). Twenty-two (81%) patients were symptomatic: dyspnea or exertional dyspnea (11, 42%) and palpitations (6, 23%) were the most frequent symptoms. Most cysts appeared as single round, oval, or lobulated anechoic masses, measuring 4–30 mm (mean, 18 mm). Half of the BCs (13, 50%) were pedunculated and mobile, and the others swung with the movement of the valve. The mitral valve (13, 50%) was the most common site of occurrence, followed by the tricuspid valve (6, 23%), right atrium (4, 15%), and aortic valve (3, 12%). Contrast echocardiography, which was performed for two patients, revealed a closed cyst without bubbles. Five cases were complicated by left ventricular outflow tract obstruction and six by valve prolapse. Eighteen patients underwent surgery, and one received antiplatelet therapy. Cardiovascular or cerebrovascular events did not occur in any patient during the follow-up period. ConclusionCardiac BCs are most commonly attached to the atrioventricular valve. Echocardiography is considered to be the most useful imaging modality for assessing BC. The management of patients with BC should be individualized based on the symptoms and associated complications.

Right atrial blood cyst of a patient with hypertrophic cardiomyopathy

Summary Intracardiac blood cysts are generally observed in infants and regress spontaneously with time. Blood cysts are mainly located on the left side of the heart and atrioventricular valves. These findings are extremely rare in older children and adults. We report a rare case of a 45-year-old female patient with a cardiac blood cyst in the right atrium and hypertrophic obstructive cardiomyopathy. To the best of our knowledge, this is the first-ever case report in the literature of blood cyst and hypertrophic cardiomyopathy.

To the casuistry of spleen blood cysts

Cases of blood cysts of the spleen are extremely rare on the operating table (Finkelstein could collect only 28 such cases from the literature), even more rare on the sectional table (only 3 cases in Finkelstein) and exquisite-rare, in the order of correct preliminary recognition.

Totally endoscopic surgical resection for a blood cyst originated from mitral valve: a case report

BackgroundIntracardiac blood cysts are very rare primary cardiac tumors. Blood cysts originated from the mitral valve represent a minority of cases, and previous cases have been mainly treated with conventional surgery through median sternotomy. When the tumor involves heart valves and histopathological diagnosis remains unknown preoperatively, minimally invasive surgical resection of an intracardiac tumor can be challenging, especially through an endoscopic approach. We herein present the first case of successful surgical resection for a rare mitral valve originated blood cyst in a minimally invasive, totally thoracoscopic approach.Case presentationAn apparently healthy 38-year-old male presented to his local hospital with six months history of palpitation and exertional dyspnea. Transthoracic echocardiography showed a mobile round cystic mass inside the left ventricle, attached to the anterolateral papillary muscle and chordae tendineae of the mitral valve. The local doctor diagnosed an intracardiac tumor and suggested a surgical resection through median sternotomy. However, the patient refused to have a sternotomy. He was then referred to us seeking minimally invasive surgery. We assessed the location, appearance and relationship to nearby structures of the tumor with echocardiography, and made a diagnosis of a suspected primary cystic intracardiac tumor. Since we had enough experience of totally endoscopic mitral surgery, our surgical plan was to resect the tumor in the aid of thoracoscopy, and manage the possible deformation and dysfunction of the cardiac structure if necessary. Using femoro-femoral cannulation and cardiopulmonary bypass, we successfully resected the tumor through a thoracoscopic approach in a closed chest, and well preserved the subvalvular structure and valvular function. Postoperative recovery was quick and uneventful. Pathologic diagnosis confirmed a simple blood cyst.ConclusionsSurgical resection is warranted for symptomatic cases of intracardiac blood cysts. With prudent preoperative diagnosis and comprehensive surgical plan, we believe the thoracoscopic approach is a safe, curative and viable alternative for complete resection of cardiac valvular tumors.

Blood cyst of the mitral valve – is it common? Case report

Abstract Cardiac blood cysts are benign tumors, usually congenital malformations, found on the endocardium, particularly along the closing lines of the heart valves. Blood cysts of the heart are commonly reported at postmortem findings in infants and they are very rare in adults. We report a case of a 39 year old patient, who was incidentally discovered during echocardiography having a blood cyst attached to the ventricular face of the anterior mitral valve and to the mitral chordae. During surgery, the cystic mass was resected. Mitral valvuloplasty was successfully performed and the patient had an uneventful recovery. Blood cysts are rarely reported, thus there is no consensus or guidelines for the optimal management of the asymptomatic cases. Although our patient was asymptomatic and the cyst did not interfere with the cardiac function, together with the heart team, we chose the surgical resection of the cardiac mass in order to prevent possible complications.

Is Surgery Really Necessary in Blood Cysts?

Blood cysts are rare cardiac tumors. Although it is considered a benign pathology, it can also be associated with embolic events. We report 42-year-old woman who admitted to our clinic with the palpitation and dyspnea on exertion. Apical diastolic murmur was present in physical examination. On echocardiography mitral valve posterior leaflet had a typical 'domed' appearance in diastole while anterior leaflet was restricted in motion with a fibrocystic formation on the ventricular side, causing mild to moderate mitral stenosis. We decided medical follow-up with the patient choice and we have been following for two years without any complications.

P173 When the heart doesn"t want to grow up

Abstract Background Blood cysts of heart valves are uncommon and, usually, incidental findings in pediatric population. Rarely seen in adults, blood cysts are normally asymptomatic, even though several cases of embolization, valvular disfunction and left ventricle outflow tract (LVOT) obstruction have been described. Clinical Presentation. We report the case of a 23 year-old woman, with history of a small nodular mass of the mitral valve, found on a previous cardiac magnetic resonance (CMR) at the age of thirteen, who was admitted to our emergency department complaining atypical chest pain. She denied shortness of breath, syncope, tachycardia and fever. She was hemodynamically stable and a fast regression of symptoms was observed. The physical examination was unremarkable. Both the electrocardiogram (ECG) and blood tests were normal. A chest radiography showed normal heart size, without other abnormalities. After having ruled out an acute coronary syndrome, the patient was discharged with the indication to undergo further cardiological assessments. Diagnostic techniques and their most important findings. Therefore, a trans-thoracic echocardiogram was performed revealing normal biventricular function, no aortic root dilation, no pericardial effusion, no valvular regurgitation or stenosis. A round (7x11 mm) mass with hyperechogenic borders and hypoechogenic content was detected on the ventricular side of the anterior mitral valve leaflet consistent with a valvular blood cyst (figure 1: a,b,c). Only trivial mitral valve regurgitation without LVOT obstruction was present. The 3D echo reconstruction allowed to confirm the suspicion of blood cyst and detect a cleft of the posterior mitral valve leaflet, located in the P2 scallop (figure 1: d,e). A repeated CMR showed no contrast enhancement of the mass. Due to the clinical stability and the absence of complications, the patient was suggested to continue an echocardiographic follow-up. Discussion. Cardiac blood cysts are a rare condition with uncertain origin, usually found in infants in the first six months of life. A natural regression after that age has been described, making this condition very unusual in adults. Despite its benign features, when persistent beyond the childhood, the blood cyst can grow and reach even huge dimensions, potentially impairing the valvular function and/or causing LVOT obstruction. Another potential complication of blood cysts may be the arterial embolization. In all these situations surgical resection must be considered. In our patient, the contribution of trans-thoracic echocardiogram and in particular the 3D reconstruction, were pivotal to address the correct diagnosis. Abstract P173 Figure 1

Enlarging blood cyst with atrial septal defect causing tricuspid obstruction

Blood cysts are benign tumors in nature and seldom need surgical removal. Herein, we report an 86-year-old patient with a blood cyst originating from the fossa ovalis accompanied by an atrial septal defect. The patient used the bizarre sleeping postures, including prostrating and worshiping, to relieve chest tightness. The septal base defect kept the tumor progressively enlarged with time, which contributed to a “ball-valve “effect and caused tricuspid flow obstruction. It was resolved after excision. This case report emphasizes that long-term follow-up and increased awareness are required for unpredictable intracardiac blood cyst development.

Right Atrial Blood Cyst Incidentally Detected by Computed Tomography for Metastatic Breast Cancer in an Adult Female Patient: A Case Report

Cardiac blood cysts are benign congenital cardiovascular tumors that are rare in adults. A 70-year-old woman who underwent left mastectomy for left breast cancer 9 years ago was referred to our institution for a right atrial mass that measured 35 × 30 mm and was detected incidentally by computed tomography for metastatic breast cancer and transthoracic echocardiography. The mass was attached to the interatrial septum by a stalk. Although it was asymptomatic, surgical resection was performed because of the risk of pulmonary embolism. The mass contained blood, and histopathological findings were suggestive of a blood cyst. We described a rare case of a right atrial blood cyst incidentally found during evaluation for metastatic breast cancer in a woman.

A Giant Blood Cyst of Mitral Valve Resulting in Severe Left Ventricular Outflow Tract Obstruction

Blood cysts of the papillary muscle of the mitral valve are rare in adults. These cysts are thin-walled, lined by flattened and cobblestone-shaped epithelium, and filled with nonorganized blood. Blood cysts are often asymptomatic, and a case resulting in severe left ventricular outflow tract obstruction and valvular dysfunction successfully treated by surgery has not been reported before. A 32-year-old man presented to the hospital with a 1-year history of chest pain and four episodes of syncope. Cardiac examination revealed a loud, harsh ejection systolic murmur throughout the precordium but greatest at the left sternal edge. Transthoracic echocardiography showed a giant mass (4.6 × 2.6 cm) with an echolucent center within the left ventricular cavity (Fig 1A-1 [AA = ascending aorta; LA = left atrium; LV = left ventricle; MV = mitral valve]). It seemed to be attached to the anterior leaflet of the mitral valve (A2). In systole, the mass prolapsed into the left ventricular outflow tract with a turbulent high-velocity systolic jet (4.9 m/second) and severe mitral regurgitation (Fig 1A-2). Left ventricular contrast echocardiography showed a giant cyst between the anterior papillary muscle of the mitral valve and the chordae tendineae (Fig 1A-3 [MI = mitral insufficiency). An emergency operation was performed with cardiopulmonary bypass for intractable chest pain. During the procedure, a smooth, oval, bluish mass (4.5 × 4 cm) was found attached by a stalk to the anterior papillary muscle of the mitral valve (Fig 1B [AML = anterior mitral leaflet; PM = papillary muscle]). The papillary muscle and anterior leaflet of the valve were excised to ensure complete clearance. In addition, a 31-mm St. Jude prosthesis (St. Jude Medical, Saint Paul, MN) was inserted. The postoperative recovery was uneventful, and the patient was symptom free and working full time during follow-up. The histopathologic examination showed a blood-filled cyst with a cyst wall composed of fibrous tissue (Fig 1C). This work was supported by 2018 Wuhan Young & Middle-Aged Medical Backbone Training Program; Health and Family Planning Commission of Wuhan municipality scientific research project (WX17Q35).

3. An enigmatic case of undiagnosed severe diarrhoea post living donor liver transplant

Background and Aims: Graft versus Host Disease (GVHD) after orthotopic liver transplant (OLT), although rare, carries >80% mortality. Early diagnosis, prompt treatment, and aggressive supportive care are imperative to potentially reverse this otherwise fatal ailment. We describe a case of recurrent severe diarrhoea post living donor OLT who was diagnosed with acute GVHD. Case Summary: A 56 year old lady underwent an uneventful (swap) living donor OLT for Hepatitis C related chronic liver disease with multifocal hepatocellular carcinoma. Initial immunosuppression consisted of tacrolimus, mycophenolate mofetil and prednisolone. At ten weeks post- transplantation, sirolimus was introduced and Tacrolimus tapered gradually. At 78 and 84 weeks post-transplantation she had two episodes of acute cellular rejection treated with pulse methylprednisolone therapy. She developed profuse watery painless diarrhoea with significant nocturnal symptoms at 90 weeks post-transplantation, for which she was admitted on several occasions. Multiple stool examinations were bland (no pus cells, red blood cells, mucus, ova and cysts), negative for cryptosporidium and clostridium difficile (antigen + toxin) and there was no Cytomegalovirus viremia. Laboratory parameters revealed mild anemia, thrombocytopenia, hypoalbuminemia and transaminitis. Celiac serology was negative. Every time her symptoms settled with intravenous fluids and antibiotics, only to recur within few days. An upper gastrointestinal endoscopy and duodenal biopsy was normal. Random normal appearing terminal ileum and colonic mucosal biopsies revealed mild active GVHD. Lamina propria showed mild chronic inflammatory cell infiltrate along with lymphoid aggregates. Few crypts demonstrated apoptosis (Fig. 1). There were no crypt dropouts, cryptitis or crypt abscesses (GVHD grade I). She was started on oral budesonide therapy. Her symptoms responded briskly and diarrhoea subsided. At six months follow-up, she was completely asymptomatic. Conclusions: This is the first case of GVHD with isolated gastrointestinal manifestations post OLT to be reported from India and treated successfully with oral budesonide. The authors have none to declare.

Coronary Artery Embolism From a Blood Cyst of the Mitral Valve

Blood cysts are benign, congenital tumours of the heart endothelium, found most commonly on heart valves. Adult cases are rare, since most spontaneously regress with age. However, reports of symptomatic cases with embolic phenomena and valve dysfunction have been described. We present a case of a previously healthy 44-year-old woman with no cardiovascular risk factors who developed acute myocardial infarction caused by coronary artery embolism from a blood cyst of the anterior mitral valve leaflet.

Prevalence of cryptosporidiosis in renal transplant recipients presenting with acute diarrhea at a single center in Pakistan.

Background: Cryptosporidium is an intracellular protozoan organism which causes diarrhea, both in immunocompetent and immunocompromised hosts. Renal transplant recipients are prone to develop a variety of infections including protozoal infections. Objectives: The aim of this study was to determine the prevalence of cryptosporidiosis in our renal transplant recipients presenting with acute diarrhea. Patients and Methods: During six months of the study, 644 renal transplant recipients presented with acute diarrhea. Single stool sample was obtained for detailed analysis including gross and microscopic examination for red blood cells, pus cells, ova, cysts, and protozoa. The modified Ziehl-Neelsen (ZN) staining was done to identify the oocysts of cryptosporidia. Results: Out of 644 renal transplant patients, oocysts of cryptosporidia were identified in 343 patients (53%). Detailed stool analysis of these patients showed the presence of numerous pus cells in 27 (7.9%) patients, co-infection with giardia intestinalis cysts in 15 (4.3%), and entamoeba histolytica cysts in 10 (2.9%). In all, out of 343 patients, 43 (12.5%) had dual infection with bacteria and protozoa in addition to cryptosporidiosis. Conclusions: Cryptosporidium is an important pathogen causing acute diarrhea in renal transplant recipients in our set up. Stool examination is usually negative for pus cells. It is recommended that in all transplant recipients presenting with acute diarrhea modified ZN staining should be done to rule out cryptosporidiosis in highly endemic areas like Pakistan.

Statistical unit root test for edge detection in ultrasound images of vessels and cysts

A new approach is proposed for edge detection in ultra- sound. The technique examines the image intensity profile for unit roots based on the Dickey-Fuller statistical test of stationarity. The existence of the unit root is a sign of nonstationarity and a possible edge. A simple algorithm to build a segmentation method based on this edge detection approach is also proposed, which is capable of delineating the perimeter of hollow structures such as blood vessels and cysts. In this approach, the radial edge profiles originating from the center of the object of interest are scanned for the change from stationary to nonstationary status. The algorithm treats the radial intensity profiles as a time series and uses the Dickey-Fuller statis- tical test along the radii to find the location at which the profile becomes nonstationary. A priori criteria for edge continuity, shape, and size of the object of interest are applied to enhance the stability of the algorithm. The accuracy is demonstrated on simulated ultra- sound. Further, the method is examined on two different image sets of blood vessels and validated based on contours marked by experts. The worst case distance from expert contours is 1.8 � 0.3 mm. The average area difference between the expert and the extracted contours is ∼6%and ∼4% of the vessel area in the two data- sets. The proposed segmentation method is also compared to seg- mentation using active contours on ultrasound images of breast and ovarian cysts and shown to be accurate and stable. © 2013 SPIE and IS&T (DOI: 10.1117/1.JEI.22.3.033013)

Right atrium giant blood cyst in a young female with acute pericarditis, complicated with fatal cardiac tamponade

Blood cysts (BC) of the heart are exceedingly rare in adults. The BC are benign cardiovascular tumors which are congenital in origin and are incidental autopsy findings in approximately 50% of infants under 2months of age. They usually regress spontaneously and are very rare after 2years of age [1,2]. Their usual size ranges from microscopic to 3mm in diameter. They are typically asymptomatic [1]. When found in adults, they can be large and may result in severe ventricular outflow tract obstruction [3].