scholarly journals P1344 Right ventricular mass: multimodality diagnostic approach to an incidental finding

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ambrozic ◽  
A Kovac ◽  
R Zbacnik ◽  
S Ponorac ◽  
P Kogoj ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Incidental Finding ◽  
Contrast Echocardiography ◽  
Interventricular Septum ◽  
Percutaneous Biopsy ◽  
Intracardiac Echocardiography ◽  
Diagnostic Approach ◽  
Right Ventricular Mass ◽  
History Of ◽  
The Right

Abstract Background Cardiac masses are rare entities and often diagnostically challenging. When incidentally found multimodality diagnostic approach is warranted for further characterization and evaluation of its contribution to the patient’s symptoms. Case report 62-year-old male, smoker, with a history of non-Hodgkin lymphoma treated with radiation and chemotherapy 10 years ago, was admitted due to subacute myocardial infarction. Coronary angiogram showed subacute occlusion of partly collateralized RCA, subsequently treated with dilatation and stenting. Echocardiography revealed signs of dilated cardiomyopathy with severely reduced left ventricular ejection fraction (EF 20%), that could be due to chemotherapy-related cardiotoxicity. On admission CTA was performed to exclude aortic dissection since the patient presented with very severe chest pain radiating to the back. It showed a heterogeneous formation within the right ventricle (RV) extending along the interventricular septum from the apex towards the tricuspid annulus, appearing to involve interventricular septum as well. According to the imaging characteristics the mass was suspected to be a liposarcoma (Figure A). With contrast echocardiography hypoechogenic formation in the RV on parasternal long-axis view could be visualized (Figure B). Due to previous history of malignancy PET scan was performed that revealed hypometabolic RV mass, suggesting a benign tumor, without any sign of metastasis. We decided for percutaneous biopsy that was done under intracardiac echocardiography (ICE) guidance using the view from the RV towards RV outflow tract (Figure C). Histology revealed proliferation of mature adipocytes, either orthotopic or multiplied (Figure D). To exclude well-differentiated liposarcoma FISH (fluorescent in situ hybridization) with amplification of MDM2 gene was undertaken, confirming benign lesion, most probably cardiac lipoma. It was concluded that the mass was an incidental finding, not related to the patient’s symptoms and not causing any functional disturbances; therefore surgical therapy could be avoided. Conclusion While echocardiography remains the first-line imaging modality, multimodality diagnostic approach is mandatory for evaluation and treatment decision of a newly-discovered cardiac mass. Histology provides definitive diagnosis and ICE could be helpful for guiding percutaneous biopsy, thus avoiding invasive open-heart procedures. Figure. Cardiac CTA (A), contrast echocardiography (B), intracardiac echocardiography (C) and histologic specimen (D) of the right ventricular mass (arrows). Abstract P1344 Figure.

475 A rare cause of right ventricular mass

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Briosa ◽  
A R Almeida ◽  
A C Gomes ◽  
A R Pereira ◽  
A Marques ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Large Mass ◽  
Behcet's Disease ◽  
Ventricular Mass ◽  
Right Ventricular Mass ◽  
History Of ◽  
The Right

Abstract Introduction Intracardiac masses are always a challenging diagnosis, especially when it involves the right side of the heart. There are multiples etiologies that can be responsible for these masses, namely thrombosis, neoplasm or vegetations. Occasionally, these may be related to an autoimmune process not yet discovered. Case Report 17-year-old male, with a previous history of genital ulcers, medicated with penicillin with complete resolution of symptoms. In January 2019, he started an history of recurrent fever, associated with right anterior thoracalgia, weight loss and oral afthosis. He went to the emergency department several times, where he was medicated with antibiotic, with partial symptom relief. Three months later, he returned to medical attention due to an episode of abundant hemoptysis, followed by hematemesis and cough. At hospital admission, he was hemodynamically stable, tachycardic (100/min) and with occasional episodes of cough. Cardiac and pulmonary auscultation were unremarkable. Thoracic CT revealed the presence of pulmonary thromboembolism (PTE) and a large mass in the right ventricle (RV). It was performed an echocardiogram (echo) that confirmed the presence of a large mass in the RV (50x53mm) from which a projecting hypermobile mass appeared to prolapse into the right atrium. Taking into account the diagnosis of PTE and the presence of a right ventricular mass, the patient was hospitalized and started anticoagulation. The case was immediately discussed with cardiac surgery, that confirmed that there was no surgical indication. During hospitalization, there were no more episodes of hemoptysis or hematemesis.Consecutive echos were performed, that did not reveal a significant decrease in mass dimensions despite anticoagulation. Viral serologies and autoimmunity panel were all negative. Cardiac RMI was performed raising the suspicion of a possible mass covered with thrombus. After discussion with rheumatology, and according to clinical signs, the hypothesis of vasculitis was placed, and the patient started treatment with steroids. This treatment had to be suspended after a few days due to an infectious intercurrence. After a course of antibiotic therapy, the patient started therapy with cyclophosphamide with good clinical and echocardiographic response (reduced mass dimensions). It was admitted Behçet’s disease with cardiac complications, and the patient was referred to the rheumatology consultation. Conclusion Behçet’s disease is a multi-system, chronic disorder that behaves like vasculitis.There are some typical clinical manifestations associated with this disease, such as oral and genital afthosis, uveitis, arthritis, skin lesions and nervous system involvement.Presentations with cardiac symptoms are one of the extremely rare manifestations of this disease, posing a challenge for the treating physician. Abstract 475 Figure. Right ventricular mass

Rheology of right ventricular outflow tract obstruction: sub-pulmonary membrane developing months after primary intervention to treat pulmonary atresia with intact interventricular septum

2021 ◽  
pp. 1-4
Author(s):  
Baher M. Hanna ◽  
Wesam E. El-Mozy ◽  
Sonia A. El-Saiedi
Keyword(s):  
Right Ventricular ◽  
Interventricular Septum ◽  
Pulmonary Atresia ◽  
Right Ventricular Outflow Tract ◽  
Rare Condition ◽  
Surgical Excision ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
The Right

Abstract Isolated sub-pulmonary membrane is a rare condition, the origin of which has been debatable. Transcatheter treatment of pulmonary valve atresia with intact interventricular septum by radiofrequency perforation and balloon dilatation to restore biventricular circulation is gaining more popularity, with improving results over time. We report in our experience of 79 cases in 10 years the development of a sub-pulmonary membrane in 4 cases: causing significant obstruction requiring surgical excision in one case that revealed a fibrous membrane on pathology; causing mild right ventricular outflow tract obstruction in another and not yet causing obstruction in 2. On cardiac MRI, the right ventricular outflow tract and the right ventricular outflow tract/pulmonary atresia angle showed no morphological abnormalities.

scholarly journals Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Agata Popielarz-Grygalewicz ◽  
Jakub S. Gąsior ◽  
Aleksandra Konwicka ◽  
Paweł Grygalewicz ◽  
Maria Stelmachowska-Banaś ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Healthy Volunteers ◽  
Global Longitudinal Strain ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Group ◽  
Glucose Metabolism Disorders ◽  
Acromegalic Cardiomyopathy ◽  
The Right

To determine whether the echocardiographic presentation allows for diagnosis of acromegalic cardiomyopathy. 140 patients with acromegaly underwent echocardiography as part of routine diagnostics. The results were compared with the control group comprising of 52 age- and sex-matched healthy volunteers. Patients with acromegaly presented with higher BMI, prevalence of arterial hypertension, and glucose metabolism disorders (i.e., diabetes and/or prediabetes). In patients with acromegaly, the following findings were detected: increased left atrial volume index, increased interventricular septum thickness, increased posterior wall thickness, and increased left ventricular mass index, accompanied by reduced diastolic function measured by the following parameters: E’med., E/E’, and E/A. Additionally, they presented with abnormal right ventricular systolic pressure. All patients had normal systolic function measured by ejection fraction. However, the values of global longitudinal strain were slightly lower in patients than in the control group; the difference was statistically significant. There were no statistically significant differences in the size of the right and left ventricle, thickness of the right ventricular free wall, and indexed diameter of the ascending aorta between patients with acromegaly and healthy volunteers. None of 140 patients presented systolic dysfunction, which is the last phase of the so-called acromegalic cardiomyopathy. Some abnormal echocardiographic parameters found in acromegalic patients may be caused by concomitant diseases and not elevated levels of GH or IGF-1 alone. The potential role of demographic parameters like age, sex, and/or BMI requires further research.

End-systolic and end-diastolic ventricular interaction

1986 ◽  
Vol 251 (5) ◽  
pp. H1062-H1075 ◽  
Author(s):  
B. K. Slinker ◽  
S. A. Glantz
Keyword(s):  
Right Ventricular ◽  
Interventricular Septum ◽  
Systolic Pressure ◽  
Direct Interaction ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Physiological Mechanisms ◽  
In Series ◽  
The Right ◽  
Transient And Steady State

Right ventricular volume affects left ventricular volume via direct interaction across the interventricular septum and series interaction because the right and left hearts are connected in series through the lungs. Because it is difficult to sort out complex physiological mechanisms in the intact circulation, the relative importance of these two effects is unknown. We used statistical analyses of transient changes in left and right ventricular pressures and dimensions following pulmonary artery and venae caval constrictions to separate and quantitate the direct (immediate) from the series (delayed) interaction effects on left ventricular size at end systole and end diastole. With the pericardium closed, direct interaction was one-half as important as series interaction at end diastole and was one-third as important at end systole. With the pericardium removed, direct interaction was one-fifth as important as series interaction at end diastole and one-sixth as important at end systole. These results suggest that differences between transient and steady-state end-systolic pressure-volume relationships are largely explained by direct interaction and that direct end-systolic interaction is important for maintaining balanced right and left heart outputs.

scholarly journals Fungal Pulmonary Valve Endocarditis Masquerading as a Pulmonary Embolism

2015 ◽  
Vol 2015 ◽  
pp. 1-2 ◽  
Author(s):  
Kevin B. Ricci ◽  
Peter H. U. Lee ◽  
Michael Essandoh ◽  
Ahmet Kilic
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Failure To Thrive ◽  
Ventricular Outflow Tract ◽  
Outflow Obstruction ◽  
Ventricular Outflow Obstruction ◽  
History Of ◽  
The Right

Septic pulmonary emboli (SPE) can be a difficult clinical entity to distinguish from thromboembolic pulmonary embolism (TPE) in a patient with history of IV drug abuse (IVDA). We present a case of a patient who presented with failure to thrive and presumed diagnosis of recurrent PE that ultimately was discovered to have fungal pulmonary valve endocarditis resulting in a right ventricular outflow obstruction. This required replacement of the pulmonary valve and repair of the right ventricular outflow tract. This case highlights difficulty in differentiating pulmonary valve endocarditis with septic emboli from chronic PE in a patient with a complex medical history.

scholarly journals Calcified Right Ventricular Fibroma in an Adult: A Case Report

2021 ◽  
Author(s):  
Huanhuan Gao ◽  
Shuai Yuan ◽  
Zhiqiang Hu ◽  
Zhelan Zheng ◽  
Shengjun Wu
Keyword(s):  
Right Ventricular ◽  
Histopathological Examination ◽  
Tumor Resection ◽  
Anterior Wall ◽  
Benign Tumors ◽  
Troublesome Symptom ◽  
History Of ◽  
The Right ◽  
Operative Recovery

Background: Cardiac fibromas are rare benign tumors of the heart composed of fibroblasts and collagen. They are common among children and adolescents but are rarely present in adults. Case presentation: We here report the case of a fifty-seven-year-old man who complaining of a 2-year history of chest tightness at rest. Transthoracic echocardiography detected a severe calcified mass protruding outside the right ventricular anterior wall near the apex. The patient was referred for tumor resection. The calcified mass was determined to be a cardiac fibroma with postoperative histopathological examination. The patient experienced an unremarkable post-operative recovery and was discharged 8 days later. Subsequent follow-up has shown complete freedom from his troublesome symptom. Conclusions: Preoperative diagnosis with various imaging modalities and early surgery are the keys to improve prognosis of patients with cardiac fibromas.

scholarly journals Simultaneous Hydatid Cysts of Both the Right Atrium and Right Ventricle

2007 ◽  
Vol 50 (3) ◽  
pp. 217-219
Author(s):  
Caner Arslan ◽  
Emir Cantürk ◽  
Egemen Duygu ◽  
Ahmet Kürsat Bozkurt
Keyword(s):  
Right Ventricular ◽  
Right Atrial ◽  
Hydatid Cysts ◽  
Hepatic Hydatid Cyst ◽  
History Of ◽  
Ischemic Attack ◽  
The Right ◽  
Work Up ◽  
Hepatic Hydatid ◽  
Fatal Complications

Hydatid disease in both chambers of the heart is very rare. Mobile right atrial and right ventricular hydatid cysts were diagnosed incidentally in the etiologic work up for a transient ischemic attack in a 77-year-old man with a history of a hepatic hydatid cyst operation. Transthoracic echocardiography was very successful in the diagnosis of both hydatid cysts. Transesophagial echocardiography and computed tomography confirmed the diagnosis. Both right atrial and right ventricular hydatid cysts were removed under cardiopulmonary bypass to prevent morbidities and potentially fatal complications.

scholarly journals Pentalogy of Fallot in a Crioulo Foal

2016 ◽  
Vol 44 (1) ◽  
pp. 4
Author(s):  
Ana Carolina Barreto Coelho ◽  
Lorena Alvariza Amaral ◽  
Carlos Anselmo Dos Santos ◽  
Jairo Jaramillo Cardenas ◽  
Clairton Marcolongo Pereira ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Septal Defect ◽  
Interventricular Septum ◽  
Clinical Signs ◽  
Cardiac Ultrasound ◽  
Atrioventricular Valve ◽  
Cardiac Malformations ◽  
The Right

Background: Cardiac anomalies account for 3.5% of congenital defects in horses. Tetralogy of Fallot (TOF) is characterized by ventricular septal defect, pulmonary stenosis, dextroposition the aorta and right ventricular hypertrophy secondary.Pentalogy of Fallot (POF) is a variation and is characterized by a defect in the right atrioventricular valve or persistence of the ductus arteriosus, in addition to the other defects observed in tetralogy. Affected animals usually have stunted growth,exercise intolerance, weakness, lethargy, cyanosis, dyspnea and syncope. The aim of this study was to describe a case of POF, as diagnosed in a Crioulo foal in southern Brazil.Case: Clinical signs were observed at the ffth day of life and were characterized by cyanosis, intense tracheal stertor, tachycardia, marked heart murmur, HR 160 bpm, RR 80 breaths/min, T 39.8°C and syncope. These signs worsened with physical activity. Endoscopic evaluation of the upper airways revealed no anatomical conformation changes or tissue dysfunction. A cardiac ultrasound showed a loss of continuity of the interventricular septum, right ventricular wall thickening, and a hyperechoic appearance of the area where the right atrioventricular valve (tricuspid) should be. The crises have become more severe and more frequent, the animal began to show signs of ischemia, such as loss of motor coordination and limited mobility. The foal died at 15 days old. At necropsy the liver was congested and had a nutmeg appearance, there was foam in the trachea, and the lungs were edematous. There was hydropericardium, and the heart was increased in size with a globoid shape. The heart had thickening of the walls of the right and left ventricle and pulmonary artery stenosis. There was also an oval orifce 2.5 cm in diameter in the interventricular septum connecting the ventricles (ventricular septal defect), an overriding aorta and aplasia of the tricuspid valve. Histologically the liver had centrilobular to mediozonal necrosis, and there was pulmonary edema and congestion.Discussion: The diagnosis of pentalogy of Fallot was based on the clinical signs, the ultrasound results and the macroscopic lesions observed at necropsy. Tetralogy of Fallot is one of the most common congenital cardiac malformations observed in horses, however, in a study of congenital malformations in this species, only 3.5% had cardiac malformations out ofthe 608 foals examined. The prevalence of heart defects in horses compared with other domestic species is relatively low (0.1% - 0.5%). In this case, the malformation was probably sporadic because the foal was the only animal to be born with this malformation on the farm. In the Crioulo breed, congenital defect reports are scarce. In a retrospective study of equine diseases in southern Brazil over a period of 35 years, malformations were not observed in 708 horses of this breed, whichis the predominant breed in the region. In the present case, the fact that the mare had another three healthy foals with the same stallion reduces the possibility that this was a case of hereditary origin. It is likely that this case is of a sporadic nature with no chance of determining the cause. The differential diagnoses in animals with lethargy, cyanosis, and exerciseintolerance or syncope include complicated or multiple cardiac defects. There are no previous reports of TOF and POF in the Crioulo breed in Brazil.Keywords: Pentalogia de Fallot, cardiac ultrasound, cardiac malformation, horse.

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