Cardiac Tumors Research Articles (Page 1)

Abstract Background Cardiac myxoma is the most common benign cardiac tumour. It is a benign tumour with functionally malignant behaviour and has the potential for systemic embolization. Some forms of myxoma are familial, others are isolated. However, the presence of right atrial myxoma has not yet been described in association with ectrodactyly and ectodermal dysplasia syndrome. Case summary A 28-year-old patient ectrodactyly and ectodermal dysplasia disorder presented to the Emergency Room with abdominal pain and anasarca for 3 weeks. A transthoracic cardiac ultrasound revealed a lobulated mass with a sessile infiltrative base between the atrial side of the tricuspid valve and the free wall of the inferior vena cava, with partial obstruction. Cardiac magnetic resonance imaging identified a non-thrombotic, polylobulated, budding mass extending from the tricuspid valve and prolapsing through the junction with the inferior vena cava. The cardiac myxoma was confirmed by an intravascular biopsy performed under transesophageal echocardiography guidance. The patient underwent surgery with clinical improvement. Discussion Rare congenital syndromes of ectrodactyly and ectodermal dysplasia have been described in the literature with various atypical plurisystemic malformations. However, cardiac involvement has rarely been described and the presence of right atrial myxoma has never been reported. This clinical case demonstrates the possible association between rare congenital syndromes of ectrodactyly and ectodermal dysplasia with the development of intracardiac myxoma. The potential tumorigenic role of variants in tumor suppressor genes, involved in urinary tract and limb development, may explain the onset of cardiac myxoma in the context of ectrodactyly and ectodermal dysplasia syndrome.

Comorbidities are a significant factor affecting the prognosis of patients with rifampicin-resistant tuberculosis (RR-TB). We evaluated the prevalence of comorbidities and their prognostic effects in a Chinese RR-TB cohort. In this study, we reviewed the clinical data of RR-TB patients who started anti-tuberculosis treatment in China between May 2018 and April 2020 by conducting a multicenter cohort study. A log-binomial regression model was used to analyze the relationship between comorbidities and the treatment outcomes of RR-TB. The burden of comorbidities among RR-TB patients in China was heavy, with 49.45% (670/1355) experiencing at least one comorbidity. The most common comorbidities were diabetes (17.79%), followed by other respiratory diseases (11.14%), other liver and kidney diseases (5.31%), hypertension (5.24%), immunodeficiency (4.94%), viral hepatitis or carriers (3.91%), severe heart disease (2.58%), tumours (1.11%), and chronic kidney disease or renal insufficiency (0.74%). Diabetes (RR = 1.31), severe heart disease (RR = 1.70), tumours (RR = 1.89), hypertension (RR = 1.28), aged ≥ 60 years (RR = 1.64) and45-59 years (RR = 1.38), ethnic minorities (RR = 1.58), retreatment cases (RR = 1.34), and those not using the bedaquiline regimen (RR = 1.92) significantly increased the risk of unfavorable treatment outcomes. While higher education or above (RR = 0.49), employment (RR = 0.51), and having a normal (R = 0.53) or overweight (R = 0.56) BMI could reduce the risk of unfavorable treatment outcomes. Patients with RR-TB beared a substantial comorbidity burden in China. Notably, the presence of comorbidities such as diabetes, severe cardiac disorders, tumours, and hypertension markedly elevate the risk of adverse treatment outcomes in these patients. It is necessary to strengthen the screening and management of comorbidities to optimize the treatment strategies.

Introduction: Primary malignant cardiac tumors are extremely rare, with an incidence rate of less than 0.005%, and among these, intimal sarcoma is a poorly differentiated, highly aggressive tumor associated with a poor prognosis. Symptoms range from fever, weight loss, dyspnea, and orthopnea to embolic phenomena leading to stroke. Pleural effusion is an uncommon and underreported manifestation of this tumor. Case Presentation: A 67-year-old woman presented to the pulmonary clinic for a work-up of a left-sided pleural effusion with a 2-month history of exertional dyspnea, palpitations, and dry cough. The Holter monitor identified episodes of atrial fibrillation, and ECHO showed moderate to severe mitral stenosis and preserved ejection fraction of 59%. Thoracocentesis revealed lymphocytic effusion, negative cytology, and culture; other labs showed unremarkable immunological markers. A PET scan revealed a small left pleural effusion with minimal FDG uptake and nonspecific increased FDG uptake within the left atrial appendage. TEE revealed a large left atrial mass, which was initially thought to be a left atrial thrombus or myxoma. Cardiac MRI characterized the mass as hyperintense on T2-weighted sequences, enhancement on the first pass of gadolinium, and hyperintense on late gadolinium enhancement sequences, suggesting malignancy, as opposed to a thrombus. The patient had tumor excision, revealing a 7.5 cm Intimal-type sarcoma with non-eventful post-op recovery. Discussion: Intimal (spindle cell) sarcoma is an aggressive cardiac tumor that typically arises from large vessels and pulmonary veins, though it rarely involves the left atrium. Histologically, these tumors show positive immunoreactivity to vimentin, osteopontin, and Murine double minute 2[MDM2] with variable expression of other markers. While vascular markers like CD31 and CD34 are usually negative, they may sometimes show focal positivity. Immunohistochemistry is vital for diagnosis, with MDM2 overexpression seen in over 70% of cases. Among these tumors, about 40% of cases metastasize to the lungs, causing left-sided pleural effusion presenting with nonspecific symptoms such as dyspnea and orthopnea, often posing diagnostic challenges due to their rarity and similarity to non-neoplastic conditions, delaying diagnosis. Intimal sarcoma prognosis is poor, with average survival ranging from 3 months to 1 year, but early surgical intervention can improve outcomes.

Introduction: Primary cardiac synovial sarcoma (PCSS) is an extremely rare cardiac tumor, representing less than 1% of all primary cardiac tumors and approximately 5% of cardiac sarcomas. Case Report: 55-year-old male with a past medical history of hypertension, hyperlipidemia, autism spectrum disorder presented to the emergency department for evaluation of progressive dyspnea on exertion. It was not associated with chest pain, fevers, chills, cough, lower extremity edema, orthopnea, paroxysmal nocturnal dyspnea or night sweats. An electrocardiogram showed normal sinus rhythm with nonspecific T-wave changes. His blood pressure was normal. Initial blood work showed mild hyperbilirubinemia, thrombocytopenia, elevated BNP and D-dimer. A CT angiogram of pulmonary artery showed a 7.5 x 4.6 cm mass arising from the right ventricle (RV). A transthoracic echocardiogram (TTE) showed right atrial (RA) and RV dilation with a large mobile heterogeneous mass taking up most of the ventricular cavity and prolapsing into the right atrium during systole, obstructing flow through the tricuspid valve with 45% of Left ventricular ejection fraction (LVEF). A cardiac MRI confirmed heterogenous RV mass with late gadolinium enhancement, attached to inferior wall of the RV causing significant compromisation RV function. Patient underwent a TTE guided endomyocardial biopsy which confirmed diagnosis of biphasic synovial sarcoma with SS18 rearrangement. The patient was started on doxorubicin and ifosfamide. However, he had adverse reaction from ifosfamide. PET scan did not show any evidence of local or distant metabolically active metastasis. At this point patient’s liver function test has improved. After multidisciplinary discussion patient was planned to continue doxorubicin therapy as an outpatient pending final surgical decision after recovery from acute rehabilitation. RV mass reduced in size on subsequent TTE. Patient is currently under evaluation of surgical resection or advance therapy. Discussion: Due to the rarity of PCSS, there are currently no established guidelines for its standard management. This case highlights the safety and feasibility of performing a TTE guided endomyocardial biopsy of a RV mass. Additionally, it also highlights efficacy of combining neo-adjunctive therapy to reduce the tumor burden in hemodynamically stable patients. This strategy may improve the likelihood of successful surgical resection and help stabilize patients for subsequent advanced therapies.

Background: Ischemic heart disease, particularly myocardial infarction (MI), remains a major global health burden with a mortality rate of 5-30%, frequently resulting in irreversible myocardial damage, adverse remodeling and chronic heart failure. While current treatments can limit acute injury, they do not restore damaged myocardium. Regenerative therapies, such as cardiosphere-derived cells (CDCs), have emerged as a novel frontier to restore viable tissue and improve cardiac function. : Aim: The study aims to evaluate the efficacy of intracoronary administration of CDCs in myocardial infarction. Methods: A comprehnsive review of clinical studies was done to analyze the effects of intracoronary infusion of CDCs in post-myocardial infarction patients. The key outcomes assessed in the study include left ventricular ejection fraction (LVEF), scar size, viable myocardial mass, and segmental contractility using cardiac MRI at baseline and follow-up. Additional parameters such as peak systolic circumferential strain (Ecc), regional wall motion and left ventricular volumes were also analyzed. The study also assesses safety outcomes such as major adverse cardiac events (MACE), arrhythmia rates, and rehospitalization. Results: The studies showed that MRI analysis of patients treated with CDCs for 6 months demonstrated a reduction in scar mass (9.4%), increases in viable heart mass and regional contractility, and regional systolic wall thickening compared to controlled groups. CDC therapy led to improved regional function of infarcted segments compared with control patients. No complications were reported within 24 hours of CDC infusion. No mortalities or cardiac tumors were reported at the end of 6 months. Mild inflammatory side effects were observed in 2% of patients. Conclusion: CDC therapy is a safe and feasible intervention for patients post-myocardial infarction, demonstrating consistent reductions in scar size and increase in viable myocardium. Regional myocardial function showed promising enhancement. These findings highlight the potential of CDCs in structural cardiac repair and localized regeneration. Further research is warranted to establish long-term clinical efficacy and functional benefits.

Background: Cardiac masses are of challenging diagnostic characterization, with differentiation difficulties on echocardiographic images, particularly in differentiating tumors from thrombi. Artificial intelligence (AI), particularly machine learning and deep learning algorithms, may enhance image interpretation. Research Question: We implemented and evaluated an AI model for characterizing cardiac masses from transesophageal (TEE) images, with magnetic resonance imaging or post-surgical histology as gold standards. Methods: A total of 53 series of TEE images of intra-atrial masses obtained from 43 patients were analyzed. Twenty-one masses were ultimately diagnosed as cardiac tumors (76% myxomas), while the remaining were classified as thrombi, or endocarditis vegetations. Regions of interest were selected from single frames by 2 investigators blinded to the final diagnosis. A repeated nested cross-validation (CV) scheme was used, consisting of 100 repetitions of a 5-fold CV with stratification at the patient level based on target labels. Hyperparameter selection was done using a 5-repetition 2-fold CV. The model included a feature selection step, followed by regularized logistic regression. A permutation test was conducted by shuffling the target labels in each external CV repetition and comparing the area under the receiver operating characteristic curve (AUC-ROC) to confirm robustness of the findings. Results: The AUC-ROC for the standard dataset was (median [Interquartile range]) 0.64 [0.60, 0.67], compared to 0.51 [0.45, 0.58] for the permuted model (p<0.001, Mann–Whitney U test). The model performance metrics included a true positive rate of 0.54 [0.51, 0.57], a true negative rate of 0.64 [0.62, 0.69], a positive predictive value of 0.50 [0.46, 0.53], a negative predictive value of 0.70 [0.68, 0.72], and 0.61 [0.59, 0.63] accuracy ( Figure ). Conclusions: Thus, AI integration in echocardiography imaging can significantly enhance diagnostic precision in distinguishing cardiac tumors from other cardiac space-occupying lesions, thus contributing to improved clinical decision-making and appropriate second-tier resource utilization.

Background Primary cardiac tumors are exceedingly rare, with the majority being benign, while malignant tumors are even less common. Cardiac intimal sarcoma represents a rare and aggressive variant of primary cardiac tumors, characterized by its stromal origin and frequent association with genetic abnormalities. They typically present with non-specific symptoms, making early diagnosis difficult. Case demonstration A 61-year-old female patient with a medical history notable for multiple neoplasms and surgical interventions is discussed. In 2006, she was diagnosed with uterine fibroids and underwent surgical excision. A decade later, in 2016, she was diagnosed with breast cancer, for which she received surgical treatment followed by radiotherapy. In 2023, the patient developed bilateral lower extremity arterial embolism, and a thrombectomy revealed a mixed thrombus. In 2024, she experienced a recurrence of arterial embolism in the left lower extremity. Following a thrombectomy, the embolus was identified as a myxoma, and subsequent echocardiographic evaluation revealed a mass within the left ventricle. Surgical intervention was performed to excise the left ventricular mass, and the final postoperative pathological examination confirmed the diagnosis of cardiac intimal sarcoma. Conclusion Cardiac intimal sarcoma of the left ventricle is an uncommon condition, and the absence of specific symptoms complicates early diagnosis, frequently resulting in misdiagnosis. While chemotherapy and gene-targeted therapies may improve patient outcomes, early and complete surgical resection is crucial for achieving long-term survival in individuals with cardiac intimal sarcoma.

Introduction: Cardiac metastases are more common than primary cardiac tumors and typically indicate poor prognosis. Lung, breast, melanoma, and lymphoma are the most frequent primary sources. Lung cancer involves the heart in only 8–10% of cases, often asymptomatically. Among nonsmokers, non-small cell lung cancer (NSCLC) particularly adenocarcinoma is most common and usually spreads to the pleura due to its peripheral origin. Intracardiac metastases, especially to the myocardium, are rare. We report a case of incidental left ventricular myocardial metastasis discovered during evaluation for syncope. Case Presentation: A 76-year-old woman with a significant smoking history presented with dizziness. Evaluation for syncope revealed normal orthostatic vitals and electrolytes. Electrocardiogram showed sinus bradycardia (heart rate 48 bpm) without QTc prolongation. Non-contrast CT of the head and CT angiography of the head and neck were unremarkable. Chest X-ray demonstrated left upper lobe atelectasis. Contrast-enhanced CT of the chest revealed bronchial obstruction in the left upper lobe and multiple pulmonary nodules in the right lung. Bronchoscopy identified a fungating mass obstructing the left upper lobe bronchus; biopsy confirmed adenocarcinoma. Transthoracic echocardiogram showed preserved left ventricular ejection fraction (60–65%), concentric hypertrophy, and grade I diastolic dysfunction. Cardiac MRI revealed a 3 cm mass along the basal anterior wall of the left ventricle with heterogeneous T2 signal intensity, consistent with myocardial metastasis. With a diagnosis of adenocarcinoma, the patient was advised to follow up as an outpatient for further oncologic management and advanced cardiac imaging. Discussion: This case highlights an incidental myocardial metastasis from lung adenocarcinoma in a patient presenting with bradycardia and dizziness, symptoms that may be related to cardiac involvement. While pericardial metastases are more common, myocardial infiltration is rare and often asymptomatic. Cardiac spread may occur via hematogenous, lymphatic, or transvenous routes and can present with arrhythmias, effusions, or hemodynamic compromise. Echocardiography is useful for initial evaluation, but cardiac MRI provides superior detail in assessing lesion characteristics and differentiating tumor from thrombus. Multimodal imaging plays a key role in identifying occult cardiac metastases that may impact clinical management.

Background: Primary cardiac lymphoma (PCL) is an extremely rare malignancy, accounting for approximately 1–2% of primary cardiac tumors and about 0.5% of extranodal lymphomas. It primarily affects immunocompetent adults, with a median age of 55–65 years, and male predominance (65–85%). Case Presentation: A 44-year-old male with well-controlled HIV on Rilpivirine presented with a 2-week history of progressive shortness of breath, facial edema, and exertional peripheral cyanosis. His physical exam confirmed facial and upper extremities edema and jugular venous distension suggestive of superior vena cava syndrome. Contrast computed tomography (CT) of the chest identified a large 12 × 6.2 × 7.5 cm lytic rib lesion invading the pleura and chest wall, accompanied by left supraclavicular, axillary, mediastinal, and upper abdominal lymphadenopathy. CT also showed a large (8.3 × 5.8 × 6.0 cm) right atrial mass causing near-complete occlusion of the superior and inferior vena cava (Fig 1A). A transthoracic echocardiogram with contrast-enhanced imaging confirmed a large right atrial mass extending into the IVC (Fig 1B). Cardiac magnetic resonance imaging (MRI) further detailed an 8.3 × 6.5 × 6.4 cm mass nearly filling the right atrium, infiltrating the interatrial septum with mass effect on left atrium and encroaching on the right superior and inferior pulmonary veins (Fig 2A). Biopsy of the rib lesion confirmed high-grade B-cell lymphoma with 11q aberration. The patient was started on Rituximab combined with E-POCH chemotherapy on day 7 of admission. A follow-up PET-CT scan after the first cycle showed significant regression of the intracardiac mass (Fig 2B.) Discussion: PCL is an uncommon extranodal lymphoma, most often presenting as diffuse large B-cell lymphoma (DLBCL). High-grade B-cell lymphoma with 11q aberration (HGBCL-11q) is a distinct entity characterized by a unique 11q gain/loss cytogenetic pattern, typically lacking MYC rearrangement and frequently showing Burkitt-like morphology. Standard treatment for primary cardiac DLBCL involves immunochemotherapy, most commonly R-CHOP unless contraindicated. Curative regimens yield 5-year survival rates of 70–80% in selected cohorts; however, prognosis worsens with advanced or extracardiac disease.

Sudden cardiac death (SCD) in adolescents is rare and often attributed to previously undiagnosed cardiac conditions, including genetic cardiomyopathies, congenital anomalies, conduction disorders, or thrombotic events. In atypical cases, intracardiac or vascular thromboembolism may resemble vegetations, posing a diagnostic challenge during postmortem evaluation. Thorough investigation, including histopathological analysis, is critical to accurately determine the cause of death. We report the case of a 14-year-old girl who experienced acute chest pain and vomiting shortly after school. Although she received immediate emergency care, she collapsed and passed away within hours. She had a history of occasional chest pain, but prior cardiac evaluations had been normal. The autopsy revealed soft, vegetation-like masses blocking both coronary ostia, raising suspicion of several potential underlying conditions. The differential diagnosis includes infective endocarditis, nonbacterial thrombotic endocarditis, thromboembolus formation, cardiac tumors, vasculitis, and iatrogenic causes. There was no evidence of infection or other common predisposing factors for the thromboembolism. The patient had been fasting during Ramadan, raising the possibility of dehydration and increased blood viscosity as contributing factors. This case highlights the potential for coronary thromboembolism to mimic vegetations. Histopathological examination can yield crucial insights that aid in establishing an accurate diagnosis. SCD in adolescents, particularly in the absence of known risk factors, warrants a comprehensive medicolegal autopsy to uncover underlying or contributing pathologies. Accurate differentiation between thromboembolism and vegetations is essential for correct diagnosis, understanding of pathophysiology, and prevention strategies.

Calcified Amorphous Tumour (CAT) of the heart (cardiac CAT) is a rare non-neoplastic cardiac mass that mimics malignancy on imaging and can cause symptoms due to flow obstruction or embolisation of calcific fragments. However, most of the time, the tumour may remain asymptomatic and is incidentally detected on transthoracic echocardiograms and Computed Tomography (CT) thorax. Cardiac CT and/or cardiac Magnetic Resonance Imaging (MRI) are used as problem-solving tools to support the diagnosis made by echocardiography. We report a unique case of a cardiac CAT in a completely asymptomatic 52-year-old male patient who came for a routine annual health check-up. Under the panel of investigations, the patient underwent a CT chest. Although the lung fields were unremarkable, a calcified lesion was detected in the mediastinum, which, after applying the volume rendering technique, was localised in the Right Atrium (RA). Following this incidental finding, the patient underwent a battery of investigations, including an echocardiogram and a cardiac MRI, after which the calcified amorphous and benign nature of the tumour was finally identified. Although benign, such tumours can have catastrophic effects if they produce mass effects, resulting in abnormal sinus rhythm or deranged filling of heart chambers. Therefore, the detection, work-up, and follow-up of such tumours is mandatory, and if symptomatic, surgical resection is indicated.

Cardiac amyloidosis is a rare condition often recognised as restrictive cardiomyopathy caused by extracellular accumulation of proteins in the myocardium. A more seldom form is amyloidoma, a solitary, localised tumour-like deposition of amyloid. A man in his forties presented with lethargy, chest discomfort and fever over the preceding three weeks. Transoesophageal echocardiography (TEE) revealed an intracardiac tumour causing severe obstruction and secondary increased diastolic pressure gradient between the left atrium and ventricle. Emergency surgery revealed large tumour masses in both atria, predominantly on the left side. The patient died perioperatively within 24 hours of admission to the local hospital. Histopathological examination confirmed the diagnosis of amyloidoma. Cardiac amyloidoma is an extremely rare finding that can lead to severe haemodynamic compromise. This case highlights the importance of considering cardiac tumours in young adults with atypical cardiac symptoms and urgent investigation with TEE.

Cardiac hemangioma (CH) is a rare benign cardiac tumor whose clinical manifestations—including arrhythmias, heart failure, and pericardial effusion—vary by anatomical location. Sarcoidosis is a multisystem disorder of unknown etiology characterized by non-caseating granulomas, commonly involving the lungs, eyes, and skin, with cardiac involvement being relatively uncommon. To date, no cases of concurrent cardiac hemangioma and cardiac sarcoidosis have been reported worldwide. We herein describe a patient with established sarcoidosis who, during follow-up, exhibited progressive enlargement of a cardiac mass. Surgical resection confirmed the co-existence of cardiac hemangioma and cardiac sarcoidosis within the same anatomical region. Based on these findings, we propose a pathophysiological mechanism wherein cardiac sarcoidosis causes microvascular injury, leading to structural alterations that may promote the development of cardiac hemangioma. The following report details the diagnostic and therapeutic course of this patient.

Introduction. Clinical manifestations of cardiac tumors are nonspecific and can be similar to various cardiovascular diseases. One of the most common sources of secondary cardiac tumors is melanoma. Diagnosis of melanoma with cardiac metastasis is difficult due to the predominantly asymptomatic course. Case description . A case report describes a rare clinical manifestation of melanoma under the guise of acute myocardial infarction in a 51-year-old patient who underwent excision of upper limb melanoma, lymphadenectomy and immunotherapy 5 years ago. The patient was prescribed combination immunotherapy with nivolumab and ipilimumab. Control examination (cardiac magnetic resonance imaging, combined positron emission-computed tomography) after 3 months demonstrated significant regression of the size and metabolic activity of tumor foci both in the heart and in other organs. Discussion. Despite the predominantly asymptomatic course, cardiac metastasis of melanoma can manifest with chest pain, ischemic abnormalities in the ECG and increased cardiac biomarkers, which creates a picture of acute coronary syndrome. The presented case demonstrates the high efficiency of combination immunotherapy in achieving regression of melanoma metastases in the heart and other organs.

Disclosure: A. Faber: None. R. Simon: None.Introduction: Paragangliomas are extra-adrenal neuroendocrine tumors derived from the embryonic neural crest cells. A portion of these tumors release catecholamines into the bloodstream, resulting in an array of symptoms often with a temporal component. Classically, patients present with episodic symptoms of headache, palpitations, sweating, and flushing. In this way, paragangliomas are similar to pheochromocytomas which are colloquially termed intra-adrenal neuroendocrine tumors. Paragangliomas account for 15% of chromaffin cell tumors though are generally located in the head, neck, or abdomen. Cardiac paragangliomas are extremely rare occurring in under 0.3% of mediastinal tumors. We present an extremely unique case of a right atrial paraganglioma. Case Presentation: A 45-year-old Nigerian male with history of prediabetes and GERD presented to the emergency room with shortness of breath. Physical exam showed a blood pressure of 133/66 mmHg, a pulse of 94 beats/minute, a respiratory rate of 20 breaths/minute, and normal temperature. EKG showed normal sinus rhythm. Cardiac markers were not elevated. Chest CT scan showed a 6 x 6 x 7 cm right atrial solid mass, possibly involving the myocardium. Patient was transferred to the intensive care unit where he underwent the following work up. Chest MRI demonstrated a 6.2 x 6.5 x 7.8 cm avidly enhancing ovoid mass adjacent to the right atrium. Left heart catheterization revealed normal coronary arteries except the right coronary artery was supplying significant blood supply to the highly vascularized large right atrial mass. Patient later underwent right atrial mass excision with cardiac surgery which required extensive surgical exploration as well as cardiac and vascular reconstruction with bovine tissue. Patient remained hemodynamically stable throughout surgery. The formal pathology report from the mass noted an extra-adrenal paraganglioma. Endocrinology was then consulted. Upon further history-taking, the patient revealed a one-year history of episodic palpitations, flushing, sweating, and anxiety. Episodes were sporadic at first but became more frequent, occurring multiple times per week. He denied any recurrence of these episodes since surgery. Prior to mass excision, no plasma or urine metanephrines were collected. Plasma metanephrines collected five days after mass excision were negative. The patient was referred to Genetics for further testing to guide follow up. Discussion: Intracardiac paragangliomas are extremely rare, accounting for <1% of all cardiac tumors. Most documented cases involve paragangliomas in the left atrium, thus making this case even more atypical. Our case fortunately had no major surgical complications despite lack of alpha blockade. This unique case reminds us the importance of considering paragangliomas in cardiac tumors for proper preparation prior to surgery.Presentation: Sunday, July 13, 2025

Cardiac myxomas are the most common primary cardiac tumours. The overall prevalence is very low and up to 25% present asymptomatically. In Asia, the data on myxomas is limited. Therefore, we aimed to outline a multi-ethnic Asian population of cardiac myxoma patients. We included all index echocardiographic diagnoses of myxoma at a tertiary cardiovascular referral centre from May 2004 to April 2021. A retrospective review of all patients' medical records was conducted. Data including patient characteristics, clinical presentation, imaging, treatment, and outcomes were collected and analysed. A total of 64 patients (mean age 66.4 years old, male 61%) were diagnosed with cardiac myxoma. The incidence of major adverse cardiovascular events (MACE) was 10 (16.1%) and 10-year mortality was 11 (17.2%). The proportion of asymptomatic patients (30.2%) increased from 15.4% before 2012 to 35.3% after 2012. Pre-existing chronic kidney disease and ischaemic heart disease were independently associated with increased risk of mortality and MACE (p-values < 0.05). Most patients (75.0%) underwent surgical resection. This was associated with a decreased risk of mortality and MACE (p-values < 0.05). The increase in the diagnosis of asymptomatic patients over the years could be attributed to increased opportunistic screening and incidental pickups. Surgical resection was associated with better outcomes. However, the poor outcomes of non-operated patients may be due to the concurrent comorbidities that preclude surgery.

Cardiac tumors, particularly papillary fibroelastomas (PFEs), often pose diagnostic challenges due to overlapping imaging characteristics with thrombi. While transthoracic and transesophageal echocardiography have high sensitivity for detecting fibroelastomas, their specificity remains limited. Tricuspid valve involvement is rare, with most cases occurring on the aortic valve. A 30-year-old male presented with exertional breathlessness for 2 months. Echocardiography revealed a mobile echogenic mass on the tricuspid valve, suggestive of PFE. Cardiac magnetic resonance imaging confirmed a non-mitotic lobulated mass, prompting surgical excision. However, histopathological examination identified the lesion as a thrombus rather than a fibroelastoma. This case underscores the importance of histopathological confirmation in differentiating between tumor and thrombus. Despite advancements in imaging, surgical excision remains a crucial approach when embolic risk is high. This report highlights the need for a multimodal diagnostic strategy to optimize patient management and reduce misdiagnosis-related complications.

The objective of our study was to assess the benefits and harms of tramadol vs placebo in adults with chronic pain. The research method was a systematic review of randomised clinical trials with meta-analysis. The review followed the Trial Sequential Analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The Cochrane Library, MEDLINE, Embase, Science Citation Index and BIOSIS were searched for trials published from inception to 6 February 2025. Studies were eligible for inclusion if they were published and unpublished randomised clinical trials comparing tramadol vs placebo in adults with any type of chronic pain. Risk of bias was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. The main outcome measures were pain level, adverse events, quality of life, dependence, abuse and depressive symptoms. We included 19 randomised placebo-controlled clinical trials enrolling 6506 participants. All outcome results were at high risk of bias. Meta-analysis and Trial Sequential Analysis showed evidence of a beneficial effect of tramadol on chronic pain (mean difference numerical rating scale (NRS) -0.93 points; 97.5% CI -1.26 to -0.60; p<0.0001; low certainty of evidence). However, the effect size was below our predefined minimal important difference of 1.0 point on NRS. Beta binomial regression showed evidence of a harmful effect of tramadol on serious adverse events (OR 2.13; 97.5% CI 1.29 to 3.51; p=0.001; moderate certainty of evidence), mainly driven by a higher proportion of cardiac events and neoplasms. It was not possible to conduct a meta-analysis of the quality of life due to a lack of data. Meta-analysis and Trial Sequential Analysis showed that tramadol increased the risk of several non-serious adverse events including nausea (number needed to harm (NNH) 7), dizziness (NNH 8), constipation (NNH 9), and somnolence (NNH 13) (all very low certainty of evidence). Tramadol may have a slight effect on reducing chronic pain levels (low certainty of evidence) while likely increasing the risk of both serious (moderate certainty of evidence) and non-serious adverse events (very low certainty of evidence). The potential harms associated with tramadol use for pain management likely outweigh its limited benefits.

Abstract Background Antiphospholipid syndrome (APS) is a rare autoimmune disorder characterized by an increased risk for both arterial and venous thrombosis. This case of a right intraventricular thrombus mimicking a cardiac tumor highlights the complexities of anticoagulation management in APS. Case Summary A right intraventricular mass was incidentally discovered in a 54-year-old woman undergoing assessment for an unexplained cerebral stroke. Imaging revealed a 27 × 15 mm pedunculated mass in the right ventricle without atrial fibrillation, intracardiac shunt lesion, or deep vein thrombosis. The patient was initially started on a direct oral anticoagulant (DOAC), but the intracardiac mass did not change in size, prompting a referral for further management. Due to the large size and high mobility of the mass, and the associated risk of pulmonary embolism, surgical resection of the mass was performed. Histopathologic examination revealed the mass to be an organized chronic thrombus. Postoperatively, the patient continued treatment with a DOAC but experienced recurrent cerebral strokes requiring 4 months’ rehabilitation, which delayed the definitive diagnosis of APS. Anticoagulation therapy was changed to therapeutic warfarin thereafter. Discussion Diagnosing a right intraventricular thrombus is particularly challenging if it is the first clinical venous thrombotic event associated with APS. This case emphasizes the importance of considering APS in patients presenting with unexplained arterial and venous thrombosis. Warfarin is preferred over DOACs unless the diagnosis of APS is ruled out, even if the thrombus is completely removed.

The most common primary cardiac tumor is myxoma. Approximately more than 75% of myxomas originate in the left atrium, either at the fossa ovalis border of the interatrial septum or at the mitral annulus. Myxoma is the most common benign tumor accounting for 50-70% of all primary benign tumors of the heart. Transthoracic echocardiography is the diagnostic tool for cardiac myxoma. Surgical excision or resection is the mainstay of treatment because of high risk of systemic embolization and pulmonary edema due to mitral valve (MV) obstruction. Traditionally, median sternotomy is the standard procedure but in the recent era, removal of cardiac myxoma via minimally invasive approach has shown to be a safe and feasible technique with some advantages, including less bleeding, minimum postoperative pain, less scar, faster recovery and improved postoperative quality of life.