scholarly journals Rapidly progressive respiratory failure with multiple halo signs on computed tomography in a patient with primary cardiac angiosarcoma derived from the right atrium: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Masaoki Saito ◽  
Takeshi Saraya ◽  
Miku Oda ◽  
Toshinori Minamishima ◽  
Ken Kongoji ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Output ◽  
Respiratory Failure ◽  
Lung Tissue ◽  
Right Atrium ◽  
Cardiac Ct ◽  
Loss Of Consciousness ◽  
Cardiac Angiosarcoma ◽  
Thoracic Ct ◽  
The Right

Abstract Background Primary cardiac neoplasms are extremely rare, with an autopsy incidence of 0.0001–0.003%. Primary cardiac sarcoma is usually derived from the right atrium and it manifests as chest pain, arrhythmia, hemoptysis, dyspnea, and fatigue. The most common target organ for metastasis of primary angiosarcoma is the lungs, but the radiological-pathological correlation has been rarely reported. Case presentation A 38-year-old healthy Japanese man was admitted to our hospital with persistent hemoptysis, exaggerated dyspnea, and two episodes of loss of consciousness in the past 3 months. Non-enhanced thoracic computed tomography (CT) revealed multiple scattered nodules with halo signs. Contrast-enhanced thoracic CT revealed a filling defect in the right atrium, which corresponded to the inhomogeneously enhancing tumor in the right atrium on enhanced electrocardiogram-gated cardiac CT. On day 2, acute respiratory failure occurred, and the patient was placed on mechanical ventilation. The patient was diagnosed with primary cardiac angiosarcoma based on the urgent transcatheter biopsied specimen of the right atrium mass and was treated with intravenous administration of doxorubicin. However, his respiratory status rapidly deteriorated, and he died on day 20. Postmortem biopsy showed that the multiple lung nodules with the halo signs corresponded to the intratumoral hemorrhagic necrosis and peripheral parenchymal hemorrhage in their background, suggesting the fragility of the lung tissue where the tumor had invaded, which caused hemoptysis. Furthermore, two episodes of loss of consciousness occurred probably due to a decreased cardiac output because of a massive tumor occupying the right atrium, recognized as an inhomogeneous centripetal enhancement on enhanced electrocardiogram-gated cardiac CT. Conclusions This case clearly demonstrated that primary cardiac angiosarcoma could expand in the right atrial cavity, which led to a decreased cardiac output resulting in repeated syncope, together with the fragility of lung tissue by tumor invasion, thereby generating a halo sign on thoracic CT.

scholarly journals Resection of primary cardiac angiosarcoma infiltrating the right atrioventricular junction and tricuspid valve: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lubna Bakr ◽  
Hussam AlKhalaf ◽  
Ahmad Takriti
Keyword(s):  
Surgical Resection ◽  
Tricuspid Valve ◽  
Right Atrium ◽  
Large Mass ◽  
Small Mass ◽  
Malignant Tumours ◽  
Atrioventricular Junction ◽  
Cardiac Angiosarcoma ◽  
Complete Surgical Resection ◽  
The Right

Abstract Background Primary cardiac tumours are extremely rare. Most of them are benign. Sarcomas account for 95% of the malignant tumours. Prognosis of primary cardiac angiosarcoma remains poor. Complete surgical resection is oftentimes hampered when there is extensive tumour involvement into important cardiac apparatus. We report a case of cardiac angiosarcoma of the right atrium and ventricle, infiltrating the right atrioventricular junction and tricuspid valve. Case presentation Initially, a 22-year-old man presented with dyspnoea. One year later, he had recurrent pericardial effusion. Afterwards, echocardiography revealed a large mass in the right atrium, expanding from the roof of the right atrium to the tricuspid valve. The mass was causing compression on the tricuspid valve, and another mass was seen in the right ventricle. Complete resection of the tumour was impossible. The mass was resected with the biggest possible margins. The right atrium was reconstructed using heterologous pericardium. The patient’s postoperative course was uneventful. Postoperative echocardiography showed a small mass remaining in the right side of the heart. Histopathology and immunohistochemistry confirmed the diagnosis of angiosarcoma. The patient underwent adjuvant chemotherapy and radiotherapy later on. He survived for 1 year and 5 days after the surgery. After a diagnosis of lung and brain metastases, he ended up on mechanical ventilation for 48 h and died. Conclusions Surgical resection combined with postoperative chemotherapy and radiotherapy is feasible even in patients with an advanced stage of cardiac angiosarcoma when it is impossible to perform complete surgical resection.

scholarly journals Performance of a capnodynamic method estimating cardiac output during respiratory failure - before and after lung recruitment

2019 ◽  
Vol 34 (6) ◽  
pp. 1199-1207
Author(s):  
Thorir Svavar Sigmundsson ◽  
Tomas Öhman ◽  
Magnus Hallbäck ◽  
Eider Redondo ◽  
Fernando Suarez Sipmann ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Respiratory Failure ◽  
Reference Method ◽  
Hemodynamic Instability ◽  
Lung Lavage ◽  
Lung Recruitment ◽  
Recruitment Manoeuvre ◽  
Percentage Error ◽  
Before And After ◽  
The Right

AbstractRespiratory failure may cause hemodynamic instability with strain on the right ventricle. The capnodynamic method continuously calculates cardiac output (CO) based on effective pulmonary blood flow (COEPBF) and could provide CO monitoring complementary to mechanical ventilation during surgery and intensive care. The aim of the current study was to evaluate the ability of a revised capnodynamic method, based on short expiratory holds (COEPBFexp), to estimate CO during acute respiratory failure (LI) with high shunt fractions before and after compliance-based lung recruitment. Ten pigs were submitted to lung lavage and subsequent ventilator-induced lung injury. COEPBFexp, without any shunt correction, was compared to a reference method for CO, an ultrasonic flow probe placed around the pulmonary artery trunk (COTS) at (1) baseline in healthy lungs with PEEP 5 cmH2O (HLP5), (2) LI with PEEP 5 cmH2O (LIP5) and (3) LI after lung recruitment and PEEP adjustment (LIPadj). CO changes were enforced during LIP5 and LIPadj to estimate trending. LI resulted in changes in shunt fraction from 0.1 (0.03) to 0.36 (0.1) and restored to 0.09 (0.04) after recruitment manoeuvre. Bias (levels of agreement) and percentage error between COEPBFexp and COTS changed from 0.5 (− 0.5 to 1.5) L/min and 30% at HLP5 to − 0.6 (− 2.3 to 1.1) L/min and 39% during LIP5 and finally 1.1 (− 0.3 to 2.5) L/min and 38% at LIPadj. Concordance during CO changes improved from 87 to 100% after lung recruitment and PEEP adjustment. COEPBFexp could possibly be used for continuous CO monitoring and trending in hemodynamically unstable patients with increased shunt and after recruitment manoeuvre.

scholarly journals Cardiac Angiosarcoma on the Right Atrium: Two Cases

2012 ◽  
Vol 45 (2) ◽  
pp. 120-123 ◽  
Author(s):  
Won Kyoun Park ◽  
Sung-Ho Jung ◽  
Ju Yong Lim
Keyword(s):  
Right Atrium ◽  
Cardiac Angiosarcoma ◽  
The Right

Cardiac Angiosarcoma of the Right Atrium with Cardiac Tamponade

2016 ◽  
Vol 12 (5) ◽  
pp. 1-5
Author(s):  
Hirotaka Sato ◽  
Kei Aizawa ◽  
Arata Muraoka ◽  
Hirohiko Akutsu ◽  
Yoshio Misawa
Keyword(s):  
Cardiac Tamponade ◽  
Right Atrium ◽  
Cardiac Angiosarcoma ◽  
The Right

scholarly journals P1697 A rare case: primary cardiac sarcoma in the left and right atrium presenting with dispnea due to mitral valvular obstruction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Akturk ◽  
T S Tan ◽  
M Mammadov ◽  
I Dincer ◽  
C Erol
Keyword(s):  
Computed Tomography ◽  
Left Atrium ◽  
Right Atrium ◽  
Bone Lesions ◽  
Cardiac Tumors ◽  
Iliac Wing ◽  
Left And Right ◽  
Primary Cardiac Sarcoma ◽  
The Right ◽  
Primary Cardiac Tumors

Abstract Introduction Primary cardiac tumors are extremely rare; the incidence is approximately 0.001% to 0.03%. Malignant tumors account for 25% of primary cardiac tumors, and among those, sarcomas are the most prevalent. We report a case of primary cardiac sarcoma presenting with dyspnea due to mitral valvuler obstruction. Case Report A 41-year-old woman was admitted to the hospital with dyspnea for 8 months without any obvious causes. She was healthy previous and without family history. Physical examination was normal. Thorax computed tomography (CT) scan was performed with the doubt of pulmonary disease. A 1x1 cm hypodense nodule was detected in superior segment of the right lower lobe lung. Positron emission tomography-computed tomography (PET-CT) revealed a 1*1 cm nodule in the lung. And also increased 18F-fluorodeoxyglucose uptake was observed in the left scapula, left iliac wing and right 4th rib, likely due to metastasis. Biopsy from the lesion of iliac wing was performed. Pathologic examination was primarily compatible with the malign mesenchymal tumor and sarcoma infiltration; but malignant epithelial tumor and metastasis of carcinoma could not be ruled out. Magnetic resonance imaging of the lung was performed to find the origin of the metastatic tumor. A 8,6 x 5,3 x 5,1 cm mass filling the right and left atria was detected.It was extending from the right atrium to the superior vena cava and also from the left atrium to the right inferior and superior pulmonary venules. The image of mass was compatible with sarcoma. Transthoracic echocardiography was performed. A mass in the left and right atrium was detected. It was filling the left atrium. Due to the mass, the maximum mitral gradient was 21 mm Hg and the mean mitral gradient was 10 mm Hg, as if there was mitral stenosis.Systolic pulmonary artery pressure was 40 mmHg. Mild mitral insufficiency was detected. The patient was evaluated with the department of oncology and cardiovascular surgery. It was decided that the mass was inoperable. So transesophageal echocardiography was not performed. It was thought that, the mass was primary cardiac sarcoma, pulmonary nodule and bone lesions were metastasis of this primary cardiac sarcoma. So chemotherapy protocol (ifosfamide,adriamycin,mesna) was started. Conclusion Cardiac tumors have many clinical presentations. Early stages of the disease are often asymptomatic. In advanced stages, patients present with symptoms of the classic triad (intracardiac obstruction, systemic embolization, constitutional symptoms) Symptoms are often non-spesific; so diagnostic suspicion is very important. Although cardiac sarcoma therapy includes complete surgical excision, followed by radiotherapy and chemotherapy, prognosis is still poor. Surgery can offer dramatic palliation of symptoms in cases of valvular obstruction. In conclusion, it remains clear that early diagnosis and treatment are extremely important because of their prognostic and therapeutic value. Abstract P1697 Figure.

scholarly journals Surgical Treatment of a Giant Primary Cardiac Angiosarcoma

2008 ◽  
Vol 51 (4) ◽  
pp. 237-239 ◽  
Author(s):  
Maruf Sanli ◽  
Bulent Tuncozgur ◽  
Alper Sevinc ◽  
Bahadir Daglar ◽  
Kemal Bakir ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Surgical Resection ◽  
Right Atrium ◽  
Combined Treatment ◽  
Histopathological Diagnosis ◽  
Cardiac Angiosarcoma ◽  
Resected Tumor ◽  
Well Differentiated ◽  
The Right ◽  
Large Primary

Primary cardiac angiosarcoma is a rare tumor, and surgical resection is often required to relieve its symptoms. A 54-year-old male with a large primary cardiac angiosarcoma is described in this case report. The tumor was located in the right atrium and right ventricle. The bulk was resected with the right coronary artery (RCA), and partial right atrium and partial right ventricle resections were performed during cardiopulmonary bypass. The resected tumor measured 15 x 10 x 8 cm, and the histopathological diagnosis was well differentiated primary cardiac angiosarcoma. In the postoperative period, the patient was followed up for 22 months, and radiotherapy and chemotherapy were performed for metastases. The optimal therapy for cardiac angiosarcoma is still controversial, but combined treatment including surgical resection should be considered.

scholarly journals Giant Interatrial Septal Lipoma Filling the Right Atrium Causing Slight Symptoms: A Case Report

2021 ◽  
Vol 24 (6) ◽  
pp. E947-E949
Author(s):  
Mingxiang Chen ◽  
Fuping Li ◽  
Haitao Zhang ◽  
Zhuyun Qin
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Interatrial Septum ◽  
Illustrative Case ◽  
Cardiac Lipoma ◽  
The Right ◽  
Almost All

Cardiac lipoma is extremely rare. Here, we present a unique illustrative case of an interatrial septal lipoma protruding into the right atrium, causing symptoms in a 54-year-old male. Echocardiogram and computed tomography showed a well-shaped, giant, and fixed mass located in the interatrial septum and right atrium. The only manifestation was palpitation, though the mass filled almost all of the atrium and compressed the superior vena cava. The patient received resection of the large-sized lipoma, which was 87mm in diameter and weighed 300-400g. Pathological exam demonstrated mature lipocytes and substantiated the diagnosis of lipoma. The patient did well postoperatively, and symptoms were resolved.

Mechanism of the Increased Venous Return and Cardiac Output Caused by Epinephrine

1957 ◽  
Vol 192 (1) ◽  
pp. 126-130 ◽  
Author(s):  
Arthur C. Guyton ◽  
Arthur W. Lindsey ◽  
Berry Abernathy ◽  
Jimmy B. Langston
Keyword(s):  
Cardiac Output ◽  
Pressure Gradient ◽  
Spinal Anesthesia ◽  
Right Atrium ◽  
Venous Return ◽  
Operating Conditions ◽  
Total Spinal Anesthesia ◽  
Vascular Walls ◽  
The Mean ◽  
The Right

The effect of epinephrine on venous return has been measured in 11 dogs under total spinal anesthesia. The mechanism by which epinephrine increases venous return seems to be to increase the tone of the vascular walls thereby increasing the mean circulatory pressure. This in turn increases the pressure gradient forcing blood from the systemic vessels toward the right atrium. By equating the recorded venous return curves with curves that depict the effect of epinephrine on the heart's ability to pump blood, it is shown that under normal operating conditions cardiac output is determined far more by the tendency for blood to return to the heart than by the heart's ability to pump blood.

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