Pericardial Mass Research Articles

Ventricular tachycardia: beginning and ending fate of a benign invasive cardiac lipoma

Cardiac lipomas are rare benign heart tumors. Their clinical manifestations primarily depend on their dimension and location. We describe a case of a 14-year-old boy complaining of palpitations. ECG showed non-sustained ventricular tachycardia (NSVT). Echocardiography and cardiac MRI showed a large apical mass suggestive of a cardiac lipoma. The patient underwent open-heart surgery which detected a pericardial mass, partially attached to the myocardium, and crossed by the distal segment of LAD. This critical anatomical relationship prevents its complete resection. The biopsy confirmed mature fat tissue. Postoperatively, Propranolol was started for NSVT episodes. After 8 months, he presented with VT recurrence. A subcutaneous ICD (S-ICD) was implanted. Two months later, he was admitted for an electrical storm with six appropriate shocks. Since then, amiodarone was added. Lipomas are not always benign and their surgery might be very difficult and unhelpful. A multidisciplinary team is crucial for their diagnosis and management.

Pericardial adipose tissue, cardiac structures, and cardiovascular risk factors in school-age children.

Aims We examined the associations of pericardial adipose tissue with cardiac structures and cardiovascular risk factors in children.Methods and results We performed a cross-sectional analysis in a population-based cohort study among 2892 children aged 10 years (2404 normal weight and 488 overweight/obese). Pericardial adipose tissue mass was estimated by magnetic resonance imaging (MRI) and indexed on height3. Left ventricular mass (LVM) and left ventricular mass-to-volume ratio (LMVR) were estimated by cardiac MRI. Cardiovascular risk factors included android adipose tissue percentage obtained by Dual-energy X-ray absorptiometry, blood pressure and glucose, insulin, cholesterol, and triglycerides concentrations. Adverse outcomes were defined as values above the 75 percentile. Median pericardial adipose tissue index was 3.6 (95% range 1.6–7.1) among normal weight and 4.7 (95% range 2.0–8.9) among overweight children. A one standard deviation (1 SD) higher pericardial adipose tissue index was associated with higher LMVR [0.06 standard deviation scores, 95% confidence interval (CI) 0.02–0.09], increased odds of high android adipose tissue [odd ratio (OR) 2.08, 95% CI 1.89–2.29], high insulin concentrations (OR 1.17, 95% CI 1.06–1.30), an atherogenic lipid profile (OR 1.22, 95% CI 1.11–1.33), and clustering of cardiovascular risk factors (OR 1.56, 95% CI 1.36–1.79). Pericardial adipose tissue index was not associated with LVM, blood pressure, and glucose concentrations. The associations showed largely the same directions but tended to be weaker among normal weight than among overweight children.Conclusion Pericardial adipose tissue is associated with cardiac adaptations and cardiovascular risk factors already in childhood in both normal weight and overweight children.

Primary malignant pericardial tumour in Lynch syndrome

BackgroundThis case represents the first report of malignant primary cardiac tumour in a patient with Lynch Syndrome associated with MSH2 pathogenic variant.Case presentationA 57-year-old woman with previous ovarian cystadenocarcinoma was admitted to the emergency room for hematic pericardial effusion. Multimodal diagnostic imaging revealed two solid pericardial vascularized masses. After pericardiectomy, the final histological diagnosis was poorly differentiated pleomorphic sarcomatoid carcinoma. During follow-up she developed an ampulla of Vater adenocarcinoma. Genetic analysis identified an MSH2 pathogenic variant.ConclusionThis case contributes to expand the tumour spectrum of Lynch syndrome, suggesting that MSH2 pathogenic variants cause a more complex multi-tumour cancer syndrome than the classic Lynch Syndrome. In MSH2 variant carriers, symptoms such as dyspnoea and chest discomfort might alert for rare tumours and a focused cardiac evaluation should be considered.

502 Secondary cardiac lymphoma complicated with tamponade

Abstract Introduction A 72-year-old lady presented with one-week history of palpitation and shortness of breath. She had pyrexia of unknown origin for 4 weeks associated with weight loss. Initial clinical examination revealed sinus tachycardia of 110 beats/min and saturations of 96% on 2L/min oxygen. Neck exam revealed a 2 x 3 cm firm mass at left supraclavicular fossa. Electrocardiogram showed sinus tachycardia at 106 beats/min. There was fixed T wave inversions over anterolateral chest leads and inferior limb leads. Chest radiograph showed enlarged cardiac silhouette and evidence of pulmonary congestion Procedure Transthoracic echocardiogram revealed a moderate pericardial effusion with an 8 x 4 cm pericardial mass compressing at the right atrioventricular groove (Figure B & C). Respiratory variation of Doppler mitral and tricuspid inflow velocities suggested cardiac tamponade (Figure A). Inferior vena cava was engorged with impaired inspiratory collapse. Left ventricular size and function were otherwise normal. Urgent pericardiocentesis was performed which yielded 1 litre of light blood stained fluid. Her had subjective improvement of symptoms. There was also resolution of sinus tachycardia and pulmonary congestion. PET/CT scan showed multiple enlarged hypermetabolic lymph nodes in multiple regions above and below the diaphragm, worrisome for malignant lymphoma. Cytological assessment of pericardial fluid showed scattered large lymphoid cells which are immunoreactive to B cell marker CD 20 (Figure E & F). Bone marrow exam showed normal marrow. First cycle of R-CEOP and intrathecal methotrexate was given. Follow-up echocardiogram in one week after chemotherapy showed complete resolution of pericardial effusion. Prior pericardial mass also showed marked reduction in size (Figure D). No tamponade physiology was present. She tolerated the chemotherapy well with complete resolution of palpitation and shortness of breath. She was discharged from hospital with outpatient follow up and continuation of chemotherapy course. Discussion Cardiac tumors are rare and secondary tumors remain the most common etiology. Most of these metastatic tumors arise from solid organs such as lung, breast, kidney, melanoma as well as lymphoma. Echocardiography is a valuable tool both in diagnosis and assessment of hemodynamic significance of cardiac masses. It also aids in diagnosis of associated condition such as pericardial effusion. In this case, the cardiac tamponade is both contributed by mechanical compression of cardiac mass coupled with moderate pericardial effusion. Successful pericardiocentesis achieved temporary normalization of tamponade physiology and aided in early histological diagnosis of malignant lymphoma with pericardial metastasis. Timely initiation of intensive systemic chemotherapy was the key to rapid tumor size reduction, complete resolution of tamponade physiology and control of recurrent pericardial effusion. Abstract 502 Figure. Echo & histology

P242 When there is no time for further imaging

Abstract Introduction Cardiac tamponade (CT) is a clinical syndrome characterized by hemodynamic abnormalities resulting from an increase in pericardial pressure due to accumulation of fluid. Tamponade is one of the cardiac emergencies where urgent management steps are crucial and life saving. Absolute goal of treatment in Cardiac tamponade is to relieve the intra-pericardial pressure and to reverse the hemodynamic shutdown, by removal of the pericardial fluid via pericardiocentesis or surgical drainage. As much inevitable as it is, pericardiocentesis is relatively contraindicated when the effusion is associated with aortic dissection or myocardial rupture due to the potential risk of aggravating the dissection or rupture via rapid pericardial decompression and restoration of systemic arterial pressure. Case description A 44-year-Old transit passenger was admitted after she developed sudden onset of palpitations, vomiting and epigastric pain. She was in sinus tachycardia when brought to the Emergency department, within minutes’ patient went into cardiac shock with severe metabolic acidosis. She was admitted to ICU and subsequently intubated. Chest X-ray showed evidence of Pleural effusion with enlarged cardiac shadow, which prompted an urgent transthoracic echocardiogram. Echo findings were consistent with clinical cardiac tamponade with a large left pericardial mass compressing the lateral LV wall and aortic root, with a color flow from the mass toward the left coronary system. Mean while the patient was rapidly deteriorating, with and patient was not stable to undergo further imaging (CT or MRI), urgent contrast echo was done to rule out vascular connection between the mass and pericardial fluid, The Echo contrast study showed no vascular connection from the mass to the pericardial space ,however there was a connection from the mass to the left coronary system as shown in the figure, based on these findings a pericardial drainage was done successfully. These findings were confirmed by contrast CT scan after patient is stabilized. Patient gradually improved clinically, was extubated successfully, the provisional diagnosis was suspicious of pheochromocytoma,however the final diagnosis not established as the patient travelled to home country for further management. Conclusion Some times, it may become clinically challenging to effectively rule out contraindications to a procedure by the gold standard modalities, specially when a patient is collapsing on the table and the clock is ticking. In such scenarios, immediate alternate approaches resulting in safe outcomes are indispensable. Likewise, in our case of emergent cardiac tamponade and a suspicious pericardial mass in a crashing patient, Transthoracic echo with Optison proved to be life saving to rule out vascular connections between cardiac mass and coronaries or pericardial fluid, when there was no time for definitive imaging modalities due to rapid deterioration of patient’s clinical status. Abstract P242 Figure.

PET/CT UTILITY FOR IDENTIFYING PLEURAL AND/OR PERICARDIAL INVASION AND ITS IMPACT ON MORTALITY

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: The presence of visceral pleural invasion (VPI) and pericardial invasion (PCI) are both separately poor markers of long-term survival in non-small cell lung cancer (NSCLC). PET-CT can help accurately stage, guide appropriate therapy as well as reduce the morbidity and costs of ineffective treatment. We present a case of a patient who had both pleural and pericardial invasion from adenocarcinoma of the lung. CASE PRESENTATION: We present a 61 year-old male veteran, with 100 pack-years and was stationed near the Chernobyl disaster who presented with hoarseness of voice, cough, dyspnea on exertion, unintentional weight loss and pleuritic chest discomfort. The patient underwent an ENT evaluation revealed paralysis of left vocal cord. Subsequently a CT of the chest revealed mediastinal/hilar lymphadenopathy, multiple pulmonary nodules, left adrenal mass, large left sided pleural effusion, and 2 pericardial masses. Echocardiogram (ECHO) confirmed 2 masses on the pericardium. PET-CT revealed intense signal in the mediastinum, peri-aortic lymph nodes, foci in the pancreas, involvement almost all of the left pleura, and the 2 pericardial masses. The SUV for the pleura and the 2 pericardial masses were 9.2 and 36. The patient underwent thoracentesis and pleural fluid analysis revealed metastatic adenocarcinoma. It was unclear what the primary source was but lung and pancreas were highly suspected. A subsequent mediastinal biopsy revealed well-moderately differentiated adenocarcinoma. Staining was positive for CK7, CDX2 and partially positive for Napsin A and CK20. It was negative for TTF-1 and CA19-9. Primary lung cancer was suspected but a pancreatic source could not be ruled out. The patient unfortunately succumbed to his severe metastatic disease shortly after his initial presentation. DISCUSSION: The presence of VPI and PCI invasion is an independent predictor of decreased long-term survival in NSCLC. Our case demonstrated a patient that has both VPI and PCI. PET/CT is useful for predicting VPI in patient that have a standardized uptake value(SUV) >4.3 and by contrast no involvement is associated with SUV less 4.3. It would be helpful if PET/CT could offer mortality prediction based on the surface area of involvement but this needs further study. Patients who did not develop PCI invasion showed encouraging long-term outcomes compared to those that do. Imaging modality, like ECHO and PET/CT are helpful in identifying PCI as seen in our patient. CONCLUSIONS: Multiple imaging techniques are essential in the diagnosis of VPI and PCI with NSCLC. The results of which are predictive of patient prognosis. This may allow a more timely work-up and identification of metastatic disease. Reference #1: Yousefi-Koma, A. et al. The Utility of Metabolic Imaging by 18F-FDG PET/CT in Lung Cancer: Impact on Diagnosis and Staging, Tanaffos 2013; 12(1): 16-25 Reference #2: Park, B. et al. Long-term survival in locally advanced non-small cell lung cancer invading the great vessels and heart, Thoracic Cancer 9 (2018) 598–605 Reference #3: Bai, J., et al. Prediction of pleural invasion using different imaging tools in non-small cell lung cancer, Ann Transl Med 2019;7(2):33 DISCLOSURES: No relevant relationships by Edward Conuel, source=Web Response No relevant relationships by Lezah McCarthy, source=Web Response No relevant relationships by Kristoffer Neu, source=Web Response No relevant relationships by Muhammad Salick, source=Web Response

SARCOMA METASTASIS CAUSING ATRIAL FIBRILLATION AND REFRACTORY PLEURAL EFFUSION

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Lungs are a primary site for metastasis of sarcomas, however malignant pleural effusion, which indicates a more widespread disease, are much rarer representing only 1-6% of all malignant effusions. We describe a case of a young man with a low-grade pelvic sarcoma that had progressive metastatic lung disease who went on to develop a refractory pleural effusion and new-onset atrial fibrillation CASE PRESENTATION: A 43-year-old male diagnosed with low-grade sarcoma in the pelvis had undergone a left hemipelvectomy. Nine months later he developed metastatic disease and underwent radiation/chemotherapy and eventually Nivolumab trial with no improvement of the disease. The patient then presented three months later with respiratory distress and atrial fibrillation (Afib). A Computed Tomography Scan(CT) of the chest showed increased muscular, bone, lung, and now pleural/ possible pericardial metastases. The CT also showed a large right-sided pleural effusion. The patient underwent thoracentesis with pleural fluid analysis demonstrating an exudative effusion, with cytology showing rare atypical large cells with high nuclear/cytoplasmic ratio consistent with malignant pleural effusion. Echocardiogram showed a new pericardial space mass likely a metastatic deposit. It was felt that mass contributes to persistent Afib. Due to recurrent pleural effusions, the patient received a PleurX catheter. This PleurX catheter initially drained well but later failed to continue to drain fluid and was removed. He later required admission to ICU due to acute hypoxic and hypercapnic respiratory failure. The patient failed to improve with non-invasive ventilation. The family declined intubation and the patient passed away on comfort measures. DISCUSSION: Metastatic pulmonary metastases arise most commonly in patients with malignant fibrous histiocytoma, synovial sarcoma, liposarcoma, & leiomyosarcoma, especially if histology is high grade. Lower grade sarcomas are considered more indolent and lung metastatic rate is lower. In our case, the patient had low-grade sarcoma which makes it more unusual. Complete resection of metastasis, when feasible, is the most important factor in determining post-metastasis survival, with the median survival of 33 months vs median survival of 11 months if resection is not done. This was not able to be done in our patient. When metastasis to the pericardium occurs it is common to see arrhythmias on ECG; the most common being PAC’s, PVC’s, and SVT's such as Afib as in our patient CONCLUSIONS: Metastatic progression of sarcoma to the lung can be managed surgically and with chemotherapy in select patients but prognosis remains poor. Pleural involvement, especially with malignant effusion, portends a very poor prognosis Reference #1: Cates CU, Virmani R, Vaughn WK, et al. Electrocardiographic markers of cardiac metastasis. Am Heart J 1986;112:1297–303. Reference #2: Marulli G, Mammana M, Comacchio G, Rea F. Survival and prognostic factors following pulmonary metastasectomy for sarcoma. J Thorac Dis. 2017;9(Suppl 12):S1305-S1315. Reference #3: Yildirim H1, Metintaş M, Ak G, Dündar E, Erginel S. Soft tissue sarcoma metastatic to pleura. Tuberk Toraks. 2008;56(2):197-200 DISCLOSURES: No relevant relationships by Edward Conuel, source=Web Response No relevant relationships by Lezah McCarthy, source=Web Response No relevant relationships by Kristoffer Neu, source=Web Response No relevant relationships by Raina Patel, source=Web Response No relevant relationships by Muhammad Salick, source=Web Response No relevant relationships by Ali Wazir, source=Web Response No relevant relationships by Robert Wilcott, source=Web Response

Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case Report

Patient: Female, 58Final Diagnosis: Pericardial effusion and massSymptoms: Fatigue • lower extremity edema • shortness of breathMedication: —Clinical Procedure: PericardiocentesisSpecialty: RheumatologyObjective:Unknown ethiologyBackground:Pericarditis is common in rheumatoid arthritis, mostly occurring as an extra-articular manifestation of the disease. We describe a patient with stable rheumatoid arthritis who presented with a large pericardial effusion and a compressive fibrotic pericardial mass. The patient had recently started treatment with a tumor necrosis factor-alpha (TNF-α) antagonist.Case Report:The patient was a 58-year-old woman with rheumatoid arthritis who presented with right ventricular compression caused by a pericardial fibrotic mass and a large pericardial effusion. The patient did not have active arthritis at the time of presentation. She had been started on treatment with a tumor necrosis factor-alpha (TNF-α) antagonist 4 months prior to this presentation. She was successfully treated with surgical pericardiectomy and resection of the pericardial mass. Pathologic analysis of the pericardial mass demonstrated fibrosis and no evidence of active inflammation, rheumatoid arthritis, opportunistic infection, or malignancy.Conclusions:We describe a patient with stable rheumatoid arthritis who developed subacute right heart compression syndrome secondary to pericardial effusion and fibrous pericardial mass. The exact cause of pericarditis and the pericardial mass remain uncertain. There is a need for increased awareness of the association between use of TNF-α antagonists and the possible development of an intrapericardial fibrotic mass and effusion.

Effect of Aerobic and Resistance Exercise on Cardiac Adipose Tissues

Epicardial and pericardial adipose tissues are emerging as important risk factors for cardiovascular disease, and there is a growing interest in discovering strategies to reduce the accumulation of fat in these depots. To investigate whether a 12-week endurance or resistance training intervention regulates epicardial and pericardial adipose tissue mass. Secondary analysis of a randomized, assessor-blinded clinical trial initiated on August 2016 and completed April 2018. This single-center, community-based study included 50 physically inactive participants with abdominal obesity. Participants were randomized to a supervised high-intensity interval endurance training (3 times a week for 45 minutes), resistance training (3 times a week for 45 minutes), or no exercise (control group). Change in epicardial and pericardial adipose tissue mass assessed by magnetic resonance imaging, based on a prespecified secondary analysis plan including 3 of 5 parallel groups. Of 50 participants (mean [SD] age, 41 [14] years, 10 men [26%]; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 32 [5]), 39 [78%] completed the study. Endurance training and resistance training reduced epicardial adipose tissue mass by 32% (95% CI, 10%-53%) and 24% (95% CI, 1%-46%), respectively, compared with the no exercise control group (56% [95% CI, 24%-88%]; P = .001 and 48% [95% CI, 15%-81%]; P < .001, respectively). While there was a nonsignificant reduction in pericardial adipose tissue mass after endurance training (11% [95% CI, -5% to 27%]; P = .17), resistance training significantly reduced pericardial adipose tissue mass by 31% (95% CI, 16%-47%; P < .001) when compared with the no exercise control group. Compared with the no exercise control group, there was an increase in left ventricular mass by endurance (20 g [95% CI, 11%-30%]; P < .001) and resistance training (18 g [95% CI, 8%-28%]; P < .001). Other cardiometabolic outcomes remained unchanged after the 12-week trial period. In individuals with abdominal obesity, both endurance and resistance training reduced epicardial adipose tissue mass, while only resistance training reduced pericardial adipose tissue mass. These data highlight the potential preventive importance of different exercise modalities as means to reduce cardiac fat in individuals with abdominal obesity. ClinicalTrials.gov identifier: NCT02901496.

Plasma renin levels are associated with cardiac function in primary adrenal insufficiency

BackgroundDespite adequate glucocorticoid (GC) and mineralocorticoid (MC) replacement therapy, primary adrenal insufficiency (AI) is associated with an increased mortality, mainly due to cardiovascular disease. The role of MC replacement is not known. Therefore, we assessed whether renin concentrations during routine GC and MC substitution therapy are associated with heart function and morphology.MethodsThirty two patients with primary AI were included in a cross-sectional case–control study. In total, 17 patients and 34 healthy controls (age: 48 ± 12 vs. 46 ± 18 years; BMI: 23 ± 3 vs. 24 ± 3 kg/m2) underwent magnetic resonance spectroscopy and imaging measurements to assess cardiac function, morphology, ectopic lipids, and visceral/subcutaneous fat mass. Patients were divided according to their actual plasma renin concentration at the study visit (Actual-Reninlow vs. Actual-Reninhigh) and their median plasma renin concentration of previous visits (Median-Reninlow vs. Median-Reninhigh).ResultsEjection fraction was higher (67 ± 5 vs. 55 ± 3%; p = 0.001) and left ventricular mass was lower (60 ± 9 vs. 73 ± 10 g/m2; p = 0.025) in Actual-Reninhigh. Median-Reninhigh was associated with lower cardiac mass (64 ± 9 vs. 76 ± 11 g/m2; p = 0.029). Blood pressure, glucose, and lipid metabolism, as well as ectopic lipid content, pericardial fat mass, and visceral/subcutaneous fat were not different between the groups. Compared with controls, ejection fraction was significantly lower in patients with AI (56 ± 4 vs. 63 ± 8%; p = 0.019). No differences were found in patients with ≤20 mg compared with >20 mg of hydrocortisone per day.ConclusionsHigher renin concentrations are associated with more favorable cardiac function and morphology in patients with primary AI.

P121Experience of use of heart MRI in differential diagnostics pericardial and cardiac mass

P121Experience of use of heart MRI in differential diagnostics pericardial and cardiac mass

P565Multi-modality imaging of pericardial masses: a case of metastatic melanoma

P565Multi-modality imaging of pericardial masses: a case of metastatic melanoma

Successful intrauterine treatment of nonimmune hydrops fetalis due to pericardial tumor

The prenatal diagnosis of pericardial tumor is extremely rare.&#x0D; It may have serious consequences such as massive pericardial&#x0D; effusion, cardiac tamponade, hydrops fetalis and fetal demise.&#x0D; We present a case of nonimmune hydrops fetalis secondary&#x0D; to pericardial mass which was successfully treated in utero&#x0D; by serial pericardiocentesis. Also, we present a review of the&#x0D; literature regarding the intrauterine interventions performed&#x0D; in pericardial tumor cases. At 24 weeks’ gestation ascites,&#x0D; diffuse subcutaneous edema at the thorax and abdomen, scalp&#x0D; edema and two masses within severe pericardial effusion were&#x0D; detected. After the pericardiocentesis performed at 25, 28 and&#x0D; 29 weeks’ gestation, ascites and scalp edema resolved, and the&#x0D; pericardial effusion regressed gradually. The size of masses did&#x0D; not change throughout the gestation. After the infant was born&#x0D; at 37 weeks’ gestation, the masses shrunk spontaneously within&#x0D; five months

A giant fibrinoid pericardial mass in a patient with rheumatoid arthritis: a case report.

Background Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints, which may extend to extra-articular organs. Extra-articular manifestations have been considered as prognostic features in RA, and pericardial disease is one of the most frequent occurrences. Rheumatoid arthritis pericarditis is usually asymptomatic and is frequently found on echocardiography as pericardial thickening with or without mild effusion. Severe and symptomatic cases are rare, but pericardial masses are even rarer. We report a patient with erosive, nodular seropositive RA, and progressive functional deterioration owing to a giant pericardial mass compressing the right cardiac chambers.Case summaryThe patient was a 79-year-old man. Cardiac magnetic resonance imaging revealed a pericardial lesion measuring 10 × 9 × 6 cm with complex structures in its interior, which had compressive effects on the right atrium and right ventricle, severely limiting diastole. Late gadolinium enhancement of the lesion walls and pericardium suggested pericarditis. Surgical resection was performed, and a soft mass with liquid content was extracted. The patient recovered well with improvements in symptoms and the functional status. Histopathological studies ruled out neoplasm, vasculitis, and infection, and the entire mass showed fibrinoid material associated with fibrinoid pericarditis.DiscussionSymptomatic RA pericarditis is a rare cardiac manifestation of RA, whilst associated significant haemodynamic compromise is even rarer. The condition could manifest with a giant compressive pericardial mass composed of fibrinous material, with particular involvement of the right ventricle. Exclusion of other conditions, such as neoplasms and infections, is necessary.

Mitral annular calcification: Can CMR be useful in identifying caseous necrosis?

Mitral annular calcification (MAC) can resemble an intracardiac mass and it is defined as a chronic degeneration of the mitral annulus. Often reported is caseous mitral annulus calcification (CMAC), a periannular, extensive calcification resembling a tumor. We report the case of a 68-year-old woman who had been hospitalized for palpitations and dyspnea. The transthoracic and transesophageal echocardiography revealed a non-homogeneous, slightly mobile, round mass, attached to the ventricular side of posterior mitral leaflet, with central echo-lucent area and without acoustic shadowing. Therefore, a cardiac magnetic resonance (CMR) was performed; delayed enhancement sequences showed a non-enhanced central core surrounded by a hyperenhanced rim (fibrous cap). To confirm the diagnosis, a multidetector computed tomography (MDCT) was performed; the MDCT showed a hyperdense mass with a hypodense center and a calcified peripheral rim. The central content had heterogeneous fluid density without significant contrast enhancement. The MDCT findings were considered highly suggestive of CMAC. CMR may be useful for the identification and definition of pericardial and myocardial masses and CMAC.

Differentiation malignant from benign pericardial effusion with diffusion-weighted MRI

To differentiate malignant from benign pericardial effusion with diffusion-weighted magnetic resonance imaging (MRI). Retrospective analysis of diffusion-weighted MRI of 41 patients (29 men and 12 women; mean 39 years) with pericardial effusion. Apparent diffusion coefficient (ADC) of pericardial fluid, and associated pericardial mass or pleural effusion was calculated. ADC of pericardial fluid was calculated by two observers and correlated withcytological analysis. Receiver operating characteristic curves and Bland-Altman plots were used. There was significant differences in the ADCs between benign and malignant pericardial effusions (p=0.001) by both observers. Mean ADC of malignant pericardial effusions was (2.92±0.29 and 2.86±0.33×10-3 mm2/s) and of benign effusions was (3.36±0.31 and 3.28±0.28×10-3 mm2/s) for both observers, respectively. The cut-off values of the ADC used for differentiating malignant from benign pericardial effusion were 3.25 and 3.05×10-3 mm2/s with areas under curve of 0.839 and 0.791, sensitivities of 88.2% and 70.6%, specificities of 69.6% and 73.9%, and accuracies of 78% and 72.5% for both observers, respectively. The overall interobserver agreement of the ADC value of pericardial effusion by both observers was significant (r=0.808, p=0.001). The interobserver agreement of malignant effusion (r=0.861, p=0.001) and benign effusion was significant (r=0.659, p=0.001). The ADC of pleural effusion is well correlated with ADC of pericardial effusion (r=0.088, p=0.001). The ADC value is a non-invasive imaging parameter that can be used for differentiation of malignant from benign pericardial fluid.

Cardiac Tamponade from Pericardial Mesothelioma Causing Acute Renal Insufficiency in Dog

Pericardial mesothelioma is a rare malignancy tumor in dog. Due to an aggressive tumor and low survival rates, mesothelioma is frequently diagnosed at an advanced stage. The objective of this clinical report is to highlight the characteristic of this malignancy tumor to help an early diagnosis and to improve the therapeutic outcomes of this neoplastic tumor. A 10-year-old crossbreed was referred to Kasetsart University Veterinary Teaching Hospital Kamphaengsaen for the evaluation of a history of abdominal distension, lethargy and weekness. During the physical examination, the dog was tachycardia and tachypnea. Ultrasonography imaging of spleen revealed an inhomogeneous appearance and thoracic radiograph showed cardiac enlargement. Electrocardigraphy examination revealed low voltage of QRS complex amplitude. A transthoracic echocardiogram showed a large pericardial effusion with cardiac tamponade and masses were visualized in pericardial sac. Pericardiocentesis was immediately performed to alleviate the cardiac tamponade and cytologic examination was performed to identify the characteristic of pericardial effusion fluid. Clinical symptoms of acute kidney injury were progressed from the second visit including azotemia, hyponatraemia, hyperkalemia and anuria. The dog died about 2 days after admission in the critical care unit. Histopathological examination of the pericardial fluid and pericardial mass confirmed the diagnosis of pericardial mesothelioma. Mesothelioma should be considered in the diagnosis of pericardial effusion in dog. An early stage detection of pericardial mesothelioma may significantly reduction in mortality and allow for more beneficial treatment.

Subcutaneous fat mass in infancy and abdominal, pericardial and liver fat assessed by Magnetic Resonance Imaging at the age of 10 years.

Fat mass development in infancy contributes to later adiposity, but its relation to ectopic fat depots is unknown. We examined the associations of infant subcutaneous fat with childhood general and organ-specific fat. Among 593 children from a population-based prospective cohort study, we obtained total subcutaneous fat mass (as sum of biceps, triceps, suprailiacal, and subscapular skinfolds thickness), central-to-total subcutaneous fat ratio (sum of suprailiacal and subscapular skinfold thickness/total subcutaneous fat) at 1.5, 6 and 24 months of age. At 10 years, we assessed BMI, fat mass index (FMI) based on total body fat by dual-energy X-ray absorptiometry, and abdominal subcutaneous, visceral and pericardial fat mass indices, and liver fat fraction by Magnetic Resonance Imaging. A higher central-to-total subcutaneous fat ratio at 1.5 months only and higher total subcutaneous fat at 6 and 24 months were associated with higher BMI, FMI and subcutaneous fat mass index at 10 years. The observed associations were the strongest between total subcutaneous fat at 24 months and these childhood outcomes (difference per 1-SDS increase in total subcutaneous fat: 0.15 SDS (95% Confidence Interval (CI) 0.08, 0.23), 0.17 SDS (95% CI 0.10, 0.24), 0.16 SDS (95% CI 0.08, 0.23) for BMI, FMI and childhood subcutaneous fat mass index, respectively). Infant subcutaneous fat measures at any time point were not associated with visceral and pericardial fat mass indices, and liver fat fraction at 10 years. Our results suggest that infant subcutaneous fat is associated with later childhood abdominal subcutaneous fat and general adiposity, but not with other organ-specific fat depots.

A 42-year-old male presenting as pericardial mass

A 42-year-old male presenting as pericardial mass

Echocardiographic characteristics of primary malignant pericardial mesothelioma and outcomes analysis: a retrospective study

BackgroundLittle is known about the echocardiographic characteristics of primary malignant pericardial mesothelioma (PPM) due to its rarity. The aim of this study was to explore the sex-specific echocardiographic patterns of PPM and risk factors for in-hospital mortality.MethodsA retrospective information retrieval was conducted for cases of PPM reported from China during 1981 and 2015. The diagnosis was made by histopathological examinations and only cases with echocardiographic descriptions were included. Data on the clinical and echocardiographic findings were collected. Difference in clinical, sex-specific echocardiographic characteristics and findings across different time periods were assessed. Logistic regression analysis was performed to explore echocardiographic risk factors for in-hospital mortality.ResultsA total of 64 patients with PPM were included, with a mean age of 39.2 ± 15.6 years and minor male dominance (40, 62.5%). The most common echocardiographic presentations were pericardial effusion (55, 85.9%), pericardial masses (36.4%) and thickening (17.3%), respectively. The positive rate of pericardiocentesis was only 20.9%. Six patients (15.4%) died among 39 cases reporting in-hospital outcome. Logistics analysis identified no clinical or echocardiographic parameters associated with in-hospital mortality (all P > 0.05).ConclusionsThe echocardiographic signs of PPM are basically nonspecific with massive pericardial effusion as the most common sign, although no echocardiographic gender differences or association with in-hospital mortality could be identified.