Large Intracardiac Mass Research Articles

Transcatheter vacuum-assisted aspiration of large intracardiac and intravascular masses.

Intravascular and intracardiac masses are usually represented by thrombi, tumours, and vegetations. They can affect both the right and left chambers of the heart and the venous and arterial circulation. Traditionally, their treatment is surgical or, in some circumstances, based on systemic anticoagulation/fibrinolysis. However, the complexity and frailty of patients who sometimes present with these conditions have pushed surgeons to find alternative minimally invasive effective treatments. While small masses can be removed with multiple devices, large masses are a more challenging problem. Vacuum-assisted aspiration systems such as the AngioVac System were developed to treat intravenous and right-sided heart thrombi. The application of the AngioVac System was widened to right-sided endocarditis and, later, to left-sided thrombi and vegetations. This review summarises the clinical results of different uses of the vacuum-assisted aspiration system to treat intravenous and intracardiac masses.

Abstract 13016: Tumor or Thrombus?: Intracardiac Thrombus Masquerading as a Tumor

Introduction: Intracardiac masses comprise thrombi, vegetations, and tumors. Multimodality imaging modalities are often relied upon for a definitive diagnosis. We present a case of a left ventricular (LV) thrombus with characteristic of on contrast echocardiography that thrombus based on cardiac MRI. The mass resolved with anticoagulation. Case: A 56-year-old male with non-ischemic cardiomyopathy was admitted for management of decompensated heart failure. Transthoracic echocardiography (TTE) showed reduced left ventricular ejection fraction of 20 to 25% with diffuse hypokinesis. There was a newly detected large intracardiac mass seen in the left ventricle (figures 1-3) that enhanced with echocardiographic contrast (figure 2). Delay enhancement imaging on cardiac MRI, however, revealed a hypodense mass suggestive of a thrombus (figure 3). The patient started anticoagulation. An echocardiogram performed a month later revealed complete resolution of mass, confirming the thrombotic nature of mass (figure). Discussion: Contrast enhancement echocardiography is very helpful for characterization of intra-cardiac masses. Tumors usually enhance with contrast while thrombi are generally dark. Our case is unusual, the cardiac mass hyper-enhanced with echocardiographic contrast but had thrombus-like characteristics on cardiac MRI. The mass was proven to be a thrombus over time since it resolved with anticoagulation. Echocardiographic contrast usually fails to penetrate hard, chronic thrombi. However loosely structured, fresh thrombi may allow some passage of contrast. This has been demonstrated in carefully conducted in-vitro studies showing that imaging characteristics of newly formed thrombus is often bright with echocardiographic contrast. This underscores the importance of multi-modality imaging to diagnose the nature of a cardiac mass.

Transatrial stenting for long-term management of cardiac tumor obstruction of the right atrium in 3 dogs.

BackgroundVenous obstruction in dogs caused by large intracardiac masses can result in severe morbidity with few safe treatments.Hypothesis/ObjectivesRetrospective study to report results after transatrial stent placement in dogs with naturally occurring cardiac masses causing venous obstruction.AnimalsThree client‐owned dogs diagnosed with large cardiac masses.MethodsRetrospective study of patients that received transatrial stents extending from the caudal vena cava, across the right atrium, and into the cranial vena cava (CrVC). Procedures, complications, and outcomes were recorded based upon medical records, referring veterinarians, and client communications.ResultsTwo dogs had similar clinical signs suggestive of congestive hepatopathy including marked ascites and lethargy. One dog had clinical signs of CrVC syndrome including head and neck swelling with pitting edema and pleural effusion. After stent placement, venous pressure gradients were decreased and repeat angiography confirmed that vascular patency was reestablished. Resolution of clinical signs was marked in all 3 dogs with only mild complications including tachyarrhythmias and hypertension in 1 dog during the perioperative period. Two dogs that required additional transatrial stent placement for reobstruction 6 and 14 months later improved after the second stent implantation. Survival times poststenting for the dogs were 3, 21, and 37 months, with cause of death related to the cardiac tumor in all dogs.Conclusions and Clinical ImportanceEndovascular transatrial stenting may provide a long‐term palliative treatment option for dogs with clinical signs attributable to tumor‐induced venous obstruction when more traditional treatments are declined or not indicated.

Tumor intracardiaco en paciente adolescente

Reports of paediatric intracardiac tumours are rare; benign tumours constitute 80% of primary cardiac neoplasms, whereas approximately 15% are malignant.Rabdomyoma and fibroma are the most common benign tumours, while sarcoma and lymphoma are the most frequent malignant tumours. Symptoms vary and depend on the size and location of the tumour. Diagnosis is made using imaging such as transthoracic or transoesophageal ultrasound, and nuclear magnetic resonance. Surgical treatment has a good outcome.We present the case of a 14-year-old teenager, with a history of a heart murmur diagnosed at the age of 8. This was asymptomatic until he reached the age of 14, when he presented acute symptoms of dyspnoea and precordial pain. A large intracardiac mass was found on transthoracic echocardiogram that was affecting electrical conduction through infiltration of the AV node creating a Mobitz II 2nd degree AV block. A primary intracardiac fibroma was confirmed by heart biopsy.

Plasmablastic lymphoma presenting as a large intracardiac mass and bilateral pleural effusions

Plasmablastic lymphoma (PBL) is a rare aggressive lymphoma arising most frequently in the oral cavity of HIV-infected patients. Rare cases of PBL have been reported in extra-oral sites, as well as in HIV-negative patients. Cardiac involvement by lymphoma is very rare. The most common primary cardiac lymphoma is diffuse large B-cell lymphoma. We report an unusual case of PBL in a 49-year-old, HIV-positive man presenting with a large intracardiac mass and bilateral pleural effusions. Histological examination of the cardiac mass biopsy and cytological evaluation of the pleural fluid demonstrated large lymphoma cells with plasmablastic differentiation. By immunohistochemistry, the large lymphoma cells expressed CD30, CD45, CD138, MUM1, and kappa light chain, were weakly positive for EMA, and were negative for T-cell and B-cell markers, lambda light chain, and human herpes virus 8 (HHV8). In situ hybridization for Epstein Barr Virus-encoded RNA (EBER) was negative in large lymphoma cells. To our knowledge, in the English literature, this is the second reported case of PBL with cardiac origin and the first reported case of PBL that presents as a combination of intracardiac mass and pleural effusions.

Coexistent of giant left atrial myxoma and severe coronary artery disease presenting with paroxysmal atrial fibrillation and syncope

Introduction: Large intracardiac mass is a rare condition but it brings extremely high-risk of hemodynamic and embolic complications [1]. Presentation is usually heart failure, syncope or embolic events, but occasionally it may have atypical symptoms even may be asymptomatic. case report: Herein we are discussing a case of a 69-year-old male with syncope due to giant left atrial myxoma and coronary artery disease. conclusion: Although atrial myxomas are the most common type of benign cardiac tumors coexistent with significant coronary artery stenosis is very rare and only a few cases available in literature. surgery performed safely despite patient age, mass size and coronary artery disease coexistence and ultimate prognosis is good. Myxomas may be symptom free despite the coexistent of severe coronary artery disease, older age and large size of the mass until a contributing factor, such as atrial fibrillation episode as in our case, bring out the symptoms. Once the myxomas are detected before any complication surgery

Myxomas in All Cardiac Chambers

(Echocardiography 2012;0:1-4)Key words: myxoma, cardiac tumor, embolic strokeCase history:A 24-year-old man presented to the emergencydepartment with inability to speak and weaknesson the right side of his body, which had begunduring a workout session 2 hours earlier. He didnot report any such symptom prior to the currentevent. Family history was negative for cardiac dis-eases or stroke. On physical examination, thevital signs were stable. Right hemiplegia andaphasia were present. A II/VI systolic murmur wasnoted at the left sternal border. The lungs wereclear to auscultation. There were no skin lesions,clubbing, or pedal edema. Electrocardiogramshowed a normal sinus rhythm. A chest x-rayshowed slight cardiomegaly. A noncontrast CT(Somatom Sensation 64, Siemens Medical Solu-tions, Erlangen, Germany) scan of the head wasunrevealing. With a presumptive diagnosis ofembolic stroke, the patient was admitted to aneurological ward unit and a cardiology consul-tation was requested for identification of thepotential cardioembolic source of stroke. A trans-thoracic echocardiography (TTE) (Vivid 7, GEUltrasound, Horten, Norway) was performed thatshowed multiple large intracardiac masses; anapical four-chamber view showed masses in allcardiac chambers (Fig. 1). The largest mass(5 9 4.1 cm) was located in the left atriumattached to the interatrial septum and protrudedinto the left ventricle during diastole (movie clipS1). Also noted were a small hypermobile mass inthe apex of the left ventricle, a right atrial massattached to the interatrial septum, and a hyper-mobile ovoid mass attached to the right ventricu-lar free wall (movie clips S2 and S3), as well as alarge hypermobile 3.8 9 3.4 cm mass at the leftventricular outflow tract (Figs. 2 and 3, movieclip S4). Transesophageal echocardiography(TEE) (Vivid 7, GE Ultrasound) showed anothermass at the entrance of the superior vena cava(movie clip S5). The patient underwent surgicalresection of the masses and six tumors wereresected (Fig. 4). Histopathological examinationof the masses was consistent with myxoma.Urinary free cortisol level, abdominal CT scan,testicular ultrasonography, and thyroid ultraso-nography were normal. Postoperative course wasuneventful and the patient was discharged onday 10 of admission. In a follow-up 10 monthslater, the patient still had some neurologicalsequelae. Repeat TTE and TEE did not showrecurrent masses. The patient’s first-degree familymembers were also subjected to a screeningechocardiography, which revealed no tumor inany of them.Myxomas are the most common type of hearttumors. About 75% of the myxomas are locatedin the left atrium and 20% in the right atrium.Only 3–4% of myxomas are detected in the leftventricle. Right ventricular myxomas are as fre-quent as the left ventricular myxomas. Multilocu-lar myxomas are very rare and only few reports ofcombined atrial and ventricular tumors areextant in the literature.

Right atrial lipomatous hypertrophy resection and reconstruction using autologus pericardium

We report a case of lipomatous hypertrophy, which is a relatively uncommon entity. The patient presented with premature atrial conduction and echocardiography showed a large intracardiac mass in the right atrium. He underwent successful resection of the mass with septal reconstruction using autologous pericardium. Pathological examination revealed benign fatty infiltration suggestive of benign lipomatous hypertrophy.

Pheochromocytoma presenting with arterial and intracardiac thrombus in a 47-year-old woman: a case report

IntroductionPheochromocytoma 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 presentationA 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.ConclusionArterial 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.

Extraskeletal Myxoid Chondrosarcoma of the Heart and Review of Current Literature

Extraskeletal myxoid chondrosarcoma (EMS) is a rare oncologic phenomenon characterized by chondroid and neurogenic differentiation in extraskeletal locations. These tumours represent fewer than 2.5% of all soft-tissue sarcomas and are most commonly found in the lower extremities, limb girdles, distal extremities, and trunk. Their presence in cardiac tissue is exceedingly unusual; just a single case of ems metastatic to the heart has been reported, and no cases of primary cardiac EMS are known.Here, we report the case of a 26-year-old man who presented to his physician with a chest wall mass. Further evaluation led to the discovery of a large intracardiac mass with multiple end-organ growths. Complete work-up of this patient included cardiac biopsy, echocardiography, magnetic resonance imaging, positron-emission tomography, computed tomography, and fluorescence in situ hybridization studies for the translocation involving the EWSR1 gene locus (22q12). Results of the foregoing studies confirmed the diagnosis of ems, but the origin of this patient's tumours remains elusive and the contention between a primary cardiac source and cardiac metastasis has yet to be resolved.This article describes the histopathology, immunohistochemistry, and chromosomal aberrations common to ems, together with the common presenting features, natural history, and prognosis.

Acinetobacter Endocarditis Presenting as a Large Right Atrial Mass: An Atypical Presentation

This paper discusses a 26-year-old woman with end-stage renal disease on hemodialysis and Acinetobacter calcoaceticus-baumannii complex endocarditis. The patient had an indwelling right internal jugular catheter that was probably the nidus of infection. Transthoracic echocardiogram revealed an atypical presentation of the endocarditis as a large intracardiac mass, measuring in centimeters and occupying more than 50% of the right atrial cavity. The mass was attached to the lateral wall of the right atrium without valvular involvement. The patient was treated with prompt removal of the indwelling catheter, intravenous antibiotics, and surgical resection of the mass with an uneventful recovery. A literature search for cases of "Acinetobacter endocarditis" reveals this as the first case reported of Acinetobacter endocarditis presenting in this manner.

Pulmonary vein metastasis of a sacral chordoma extending into the left atrial cavity

Chordomas are rare malignant tumors that rise from notochordal remnants of the developing spine. Distant metastases are rare and mostly occur in patients with local recurrence. In the case reported, 14 years after radical resection of a sacral chordoma, a distant metastasis to the left pulmonary vein with large intracardiac mass, location never described before, was diagnosed. No evidence of local recurrence was observed. Although the intracardiac tumor part was successfully resected, the patient died of heart failure.

A rare case of primitive right atrium angio-sarcoma with favorable outcome, in a young female: Case report and literature review

Primary malignant cardiac tumors are extremely rare, but their associated mortality is very high. The clinical presentation is oñen variable and nonspecific; by the time symptoms appear, the tumor has usually evolved to a large intracardiac and paracardiac mass causing considerable hemodynamic involvement, regional invasión and distant dissemination. We report a 26 year-old female with a right atrium angiosarcoma with a surprisingly favorable outcome at 2 years follow-up after treatment with a combination of neoadjuvant chemotherapy and surgical resection. She presented with chest tightness, shortness of breath at effort, atypical chest pain, palpitations, asthenia, weight loss and profuse perspiration. Physical examination and irnaging diagnostic procedures, identified a pericardial effusion and a pathologic cardiac mass. The diagnosis of a malignant angiosarcoma was suggested afier computed tomography transthoracic and transesophageal echocardiography It was confirmed at surgery by a biopsy followed by histopathology and immunohistochemistry.

Recent Malignant Dyspnea

A 61-year-old man, consulted the clinic for dyspnea and cough worsening for 15 days. His past medical history was limited to a cutaneous melanoma 15 years previously, treated by surgery. He was thought to be cured, and was relapse free for the subsequent five years. Echocardiography revealed a large intracardiac mass occupying at least three quarters of the right ventricle, extending to the outflow tract. Echocardiography, MRI findings and anatomopathological examination are presented. Melanoma metastasis is discussed, with particular attention to cardiac localizations.

Solid intracardiac mass complicating peritoneovenous shunting

A 62-year-old man with liver cirrhosis and esophageal varices had received a peritoneovenous shunt (Denver shunt) in 1997. He was then re-admitted in 2005 with the clinical signs of recurrent ascites formation. The presence of a large intracardiac mass at the tip of the Denver shunt was demonstrated and the patient was referred to us for surgical removal of what was believed to represent a large right atrial thrombus potentially obstructing the shunt. After opening of the right atrium, a solid intracardiac mass at the tip of the Denver shunt was found, extending across the tricuspid valve and into the right ventricular cavity. After resection of the mass at its tip and appropriate shortening, the Denver shunt appeared to be patent. On histopathologic examination, the resected mass appeared as calcified fibrosis with hyalinized collagen fibers. However, later it was determined that ascites drainage by means of the Denver shunt remained insufficient and the patient received a transjugular intrahepatic portosystemic shunt (TIPS), which has improved his condition since then.

A Case of Posterior Loculated Tamponade Masquerading as an Atrial Mass on Transesophageal Echocardiography

Localized cardiac tamponade has been known to appear in a variety of ways on imaging studies. A loculated pericardial hematoma leading to localized tamponade may appear on imaging studies as a cardiac mass. The differential diagnosis of this mass as extracavitary, intramural, or intracavitary disease on imaging studies is usually challenging and difficult. Imaging studies such as echocardiography and computed tomography can frequently lead to misdiagnosis of these loculated pericardial hematomas as intracardiac masses, leading to unnecessary surgical procedures. 1 Although transesophageal echocardiography (TEE) has been used as a procedure of choice in the diagnosis of pericardial and intracardiac disease, especially of a posterior location, we present the case of a 72-year-old man who underwent thoracotomy for an apparent large intracardiac mass on echocardiography, which turned out to represent a loculated pericardial hematoma posterior to the left atrium (LA), causing loculated tamponade, which had almost completely compressed the LA from behind, simulating a left atrial mass. The role of echocardiographic imaging interpretation in relation to the clinical setting is emphasized and discussed.

Doppler myocardial imaging: A new method of data acquisition for three-dimensional echocardiography

The precise morphologic characteristics of any intracardiac tumor have important implications regarding surgical planning and operative repair. Three-dimensional echocardiography has proved to be a valuable clinical technique in this field. Current methods of three-dimensional reconstruction of two-dimensional images are based on the standard gray-scale imaging technique. However, precordial gray-scale data-set information is frequently of suboptimal quality because of data degradation caused by ultrasound attenuation by chest wall structures. This has limited the use of the transthoracic three-dimensional technique to “echogenic” patients. Doppler myocardial imaging (DMI), a new ultrasound technique based on the Doppler principle, is influenced less by chest wall attenuation and in addition offers a better boundary detection algorithm for the cardiac structures. To determine if there may be a potential benefit of DMI to acquire data for three-dimensional reconstruction, a 33-year-old woman with a large intracardiac mass was studied. In this case three-dimensional gray-scale and DMI data sets were compared and contrasted with pathologic information. DMI allowed both the quantification of mass volume and the correct definition of the morphology of the mass. It was also possible to identify the precise site of attachment of the mass to the mitral valve leaflets. The information thus obtained was correlated with both operative and pathologic findings.

Embryonal Carcinoma Metastasis Presenting as a Right Heart Mass

A 19-year-old boy was hospitalized with symptoms of weakness, fever and asphyxiai fits. In his history there was an orchiectomy because of embryonal carcinoma. Chest X-ray showed many solid métastasés in the lungs, ECG revealed low voltage and right atrial strain, echocardiogram gave the diagnosis of an extremely large intracardiac tumor mass. Operation or cytostatic therapy was not possible because of extensive dissemination. The patient died on the 5th day of observation. The patient could not be followed up after orchiectomy because of his poor compliance, thus 9 months later almost all the possible signs and symptoms of an intracardiac tumor were present. Thus diagnosis was made in vivo, and we could visualize an extremely large tumor mass in the right ventricle of the heart.

Adult intracardiac rhabdomyoma resembling the extracardiac variant

Rhabdomyomas are benign striated muscle neoplasms that may assume a number of characteristic histologic patterns. These lesions may be classified as cardiac or extracardiac on the basis of their location and histology. We present a case of a large intracardiac mass with the morphologic features of an extracardiac rhabdomyoma occurring in an adult female.