P844 A stroke of bad fortune

Abstract Case description We report the case of a 78 year old man who was referred to our hospital following identification of an intracardiac mass on transthoracic echocardiogram (TTE). The study was for work-up of a recent left middle cerebral artery thromboembolic stroke, with successful endovascular clot retrieval. His only other active medical issue was metastatic prostate cancer with bony involvement, on palliative hormone therapy with a well controlled prostate specific antigen level. He was an ex-smoker and and had an ECOG performance status of zero. On physical examination, the patient was clinically well, with unremarkable cardiopulmonary auscultation. The TTE demonstrated an echodense mass in the left atrium (LA), with Doppler colour giving a suggestion of its size (image A). The subsequent transoesophageal echocardiogram illustrated a large, well defined, heterogenous, echodense mass dominating the LA (image B). It was not adherent to the interatrial septum. There was no significant spontaneous echocontrast or thrombus formation in the left atrial appendage (LAA). Considering the location of the mass, the presumptive diagnosis of atrial myxoma was less likely. Differential diagnoses we considered included pure thrombus, infection and benign or malignant cardiac tumours. It was unlikely that this patient had a pure thrombus only considering the LAA was clear. He also did not have any non-specific or focal clinical features suggestive of infection. The patient went on to have a gated CT thoracic aortogram, which showed a contrast-enhancing soft tissue mass within the LA measuring approximately 50x40 millimetre, which invaded into the left inferior pulmonary vein, and was contiguous with a soft tissue mass in the left lower lobe of the lung (image C). He also had a positon emission tomography scan, which showed the highly metabolically active mass in the lung invading into the left inferior pulmonary vein, and as well as left atrium (image D). The patient underwent a biopsy of this left lower lung lesion, which confirmed squamous cell carcinoma of lung origin. Due to the large tumour burden in the LA, the joint decision with medical and radiation oncology teams, was not to administer systemic chemo- or localised radiotherapy, as this would lead to high risk of tumour embolisation. The patient also had a short period of therapeutic anticoagulation with intravenous unfractionated heparin to treat the likely thrombotic coating to the left atrial tumour extension, but developed a retroperitoneal haematoma, and hence anticoagulation was ceased. The patient was referred to palliative care services, and returned back to the community. Conclusion Cardiac tumours, whether primary or secondary, are rare. They are most frequently identified on post-mortem examination. This case is unusual, in that the patient had a second primary tumour and has remained completely asymptomatic prior to embolic presentation, despite the large size of the mass. Abstract P844 Figure 1.

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Secondary Pulmonary Vein Stenosis Due to Total Anomalous Pulmonary Venous Connection Repair in Children: Extravascular MDCT Findings

Children ◽

10.3390/children8090726 ◽

2021 ◽

Vol 8 (9) ◽

pp. 726

Author(s):

Edward Y. Lee ◽

Sara O. Vargas ◽

Kathy J. Jenkins ◽

Ryan Callahan ◽

Halley J. Park ◽

...

Keyword(s):

Soft Tissue ◽

Pulmonary Vein ◽

Soft Tissue Mass ◽

Ground Glass Opacity ◽

Pulmonary Vein Stenosis ◽

Mdct Angiography ◽

Tissue Mass ◽

Pleural Thickening ◽

Vein Stenosis ◽

Anomalous Pulmonary Venous Connection

Purpose: To evaluate extravascular findings on thoracic MDCT angiography in secondary pulmonary vein stenosis (PVS) due to total anomalous pulmonary venous connection (TAPVC) repair in children. Materials and Methods: All patients aged ≤18 years with a known diagnosis of secondary PVS after TAPVC repair, confirmed by echocardiography, conventional angiography, and/or surgery, who underwent thoracic MDCT angiography studies between July 2008 and April 2021 were included. Two pediatric radiologists independently examined MDCT angiography studies for the presence of extravascular thoracic abnormalities in the lung, pleura, and mediastinum. The location and distribution of each abnormality (in relation to the location of PVS) were also evaluated. Interobserver agreement between the two independent pediatric radiology reviewers was studied using kappa statistics. Results: The study group consisted of 20 consecutive pediatric patients (17 males, 3 females) with secondary PVS due to TAPVC repair. Age ranged from 2 months to 8 years (mean, 16.1 months). In children with secondary PVS due to TAPVC repair, the characteristic extravascular thoracic MDCT angiography findings were ground-glass opacity (19/20; 95%), septal thickening (7/20; 35%), pleural thickening (17/20; 85%), and a poorly defined, mildly heterogeneously enhancing, non-calcified soft tissue mass (17/20; 85%) which followed the contours of affected pulmonary veins outside the lung. There was excellent interobserver kappa agreement between two independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: Our study characterizes the extravascular thoracic MDCT angiography findings in secondary pediatric PVS due to TAPVC repair. In the lungs and pleura, ground-glass opacity, interlobular septal thickening, and pleural thickening are common findings. Importantly, the presence of a mildly heterogeneously enhancing, non-calcified mediastinal soft tissue mass in the distribution of the PVS is a novel characteristic thoracic MDCT angiography finding seen in pediatric secondary PVS due to TAPVC repair.

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COR TRIATRIATUM WITH INTACT SUBDIVIDING DIAPHRAGM AND PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION TO THE PROXIMAL LEFT ATRIAL CHAMBER (AN UNREPORTED TYPE)

PEDIATRICS ◽

10.1542/peds.47.4.745 ◽

1971 ◽

Vol 47 (4) ◽

pp. 745-750

Author(s):

James W. Wilson ◽

Thomas P. Graham ◽

John A. Gehweiler ◽

Ramon V. Canent

Keyword(s):

Left Ventricle ◽

Left Atrium ◽

Pulmonary Vein ◽

Left Atrial ◽

Cor Triatriatum ◽

Hypoplastic Left Ventricle ◽

Inferior Pulmonary Vein ◽

Superior Pulmonary Vein ◽

The Right ◽

Anomalous Pulmonary Venous Connection

The clinical, cardiac catheterization, and postmortem findings are presented in a 9-day-old infant with cor triatriatum, anomolous pulmonary venous connections, and a hypoplastic left ventricle. The dorsal accessory left atrial chamber did not communicate with the ventral or proximal left atrium, but did have a small connection with the right atrium. The left superior pulmonary vein connected with the accessory left atrium while the left inferior pulmonary vein connected with the proximal left atrium. The latter pulmonary venous connection has not been described previously in classical cor triatriatum and raises new embryological considerations.

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Extravascular MDCT Findings of Pulmonary Vein Stenosis in Children with Cardiac Septal Defect

Children ◽

10.3390/children8080667 ◽

2021 ◽

Vol 8 (8) ◽

pp. 667

Author(s):

Edward Y. Lee ◽

Ryan Callahan ◽

Sara O. Vargas ◽

Kathy J. Jenkins ◽

Halley J. Park ◽

...

Keyword(s):

Soft Tissue ◽

Pulmonary Vein ◽

Pediatric Patients ◽

Septal Defect ◽

Soft Tissue Mass ◽

Pulmonary Vein Stenosis ◽

Mdct Angiography ◽

Tissue Mass ◽

Pleural Thickening ◽

Vein Stenosis

To retrospectively investigate the extravascular thoracic MDCT angiography findings of pulmonary vein stenosis (PVS) in children with a cardiac septal defect. Materials and Methods: Pediatric patients (age ≤ 18 years) with cardiac septal defect and PVS, confirmed by echocardiogram and/or conventional angiography, who underwent thoracic MDCT angiography studies from April 2009 to April 2021 were included. Two pediatric radiologists independently evaluated thoracic MDCT angiography studies for the presence of extravascular thoracic abnormalities in: (1) lung and airway (ground-glass opacity (GGO), consolidation, pulmonary nodule, mass, cyst, septal thickening, fibrosis, and bronchiectasis); (2) pleura (pleural thickening, pleural effusion, and pneumothorax); and (3) mediastinum (mass and lymphadenopathy). Interobserver agreement between the two independent pediatric radiology reviewers was evaluated with kappa statistics. Results: The final study group consisted of 20 thoracic MDCT angiography studies from 20 consecutive individual pediatric patients (13 males (65%) and 7 females (35%); mean age: 7.5 months; SD: 12.7; range: 2 days to 7 months) with cardiac septal defect and PVS. The characteristic extravascular thoracic MDCT angiography findings were GGO (18/20; 90%), septal thickening (9/20; 45%), pleural thickening (16/20; 80%), and ill-defined, mildly heterogeneously enhancing, non-calcified soft tissue mass (9/20; 45%) following the contours of PVS in the mediastinum. There was a high interobserver kappa agreement between two independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: PVS in children with a cardiac septal defect has a characteristic extravascular thoracic MDCT angiography finding. In the lungs and pleura, GGO, septal thickening, and pleural thickening are frequently seen in children with cardiac septal defect and PVS. In the mediastinum, a mildly heterogeneously enhancing, non-calcified soft tissue mass in the distribution of PVS in the mediastinum is seen in close to half of the pediatric patients with cardiac septal defect and PVS.

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Mediastinal and hilar soft tissue mass‐like lesions in congenital unilateral pulmonary vein atresia: A retrospective review of seven pediatric patients

Pediatrics International ◽

10.1111/ped.14307 ◽

2020 ◽

Vol 62 (11) ◽

pp. 1234-1240

Author(s):

Reiko Okamoto ◽

Osamu Miyazaki ◽

Hidekazu Aoki ◽

Yoshiyuki Tsutsumi ◽

Mikiko Miyasaka ◽

...

Keyword(s):

Soft Tissue ◽

Pulmonary Vein ◽

Retrospective Review ◽

Pediatric Patients ◽

Soft Tissue Mass ◽

Tissue Mass

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Left Atrial Myxoma with an Unusual Origin near Right Pulmonary Vein

Journal of Perioperative Echocardiography ◽

10.5005/jp-journals-10034-1067 ◽

2017 ◽

Vol 5 (1) ◽

pp. 31-33

Author(s):

Vandana Bhardwaj ◽

Neeti Makhija ◽

Amolkumar Bhoje ◽

Kamal K Chitara

Keyword(s):

Left Atrium ◽

Pulmonary Vein ◽

Left Atrial ◽

Interatrial Septum ◽

Atrial Myxoma ◽

Left Atrial Myxoma ◽

Cardiac Tumours ◽

Rare Case Report ◽

The Right ◽

Unusual Origin

ABSTRACT Atrial myxoma is the most frequent intracardiac tumor, accounting for nearly 50% of benign cardiac tumours in adults. We present here a rare case report of a solitary left atrial myxoma attached to the left atrial wall near the origin of the right pulmonary vein. The stalk of tumor was not attached to the interatrial septum, which is the most common site of attachment. Instead, it was attached on the wall of left atrium adjacent to the interatrial septum. Surgical exploration confirmed its attachment in the left atrium near the origin of right upper pulmonary vein. How to cite this article Bhardwaj V, Makhija N, Bhoje A, Chitara KK. Left Atrial Myxoma with an Unusual Origin near Right Pulmonary Vein. J Perioper Echocardiogr 2017;5(1):31-33.

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Metastatic renal cell carcinoma extending to the left atrium through the inferior pulmonary vein

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivab018 ◽

2021 ◽

Author(s):

Alan G Dawson ◽

Cathy J Richards ◽

Leonidas Hadjinikolaou ◽

Apostolos Nakas

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Left Atrium ◽

Pulmonary Vein ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Pulmonary Veins ◽

Lower Lobe ◽

Inferior Pulmonary Vein ◽

The Right

Abstract Metastatic renal cell carcinoma with involvement through the pulmonary veins to the left atrium is very rare. We report the case of a 70-year-old male with metastatic renal cell carcinoma to the right lower lobe of the lung abutting the inferior pulmonary vein with extension to the left atrium without pre-operative evidence. Surgical resection was achieved through a posterolateral thoracotomy. Lung masses that abut the pulmonary veins should prompt further investigation with a pre-operative transoesophageal echocardiogram to minimize unexpected intraoperative findings.

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