scholarly journals Neonatal cardiogenic shock revealing obstructive cardiac Hibernoma: case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rym Gribaa ◽  
Marwen Kacem ◽  
Sami Ouannes ◽  
Wiem Majdoub ◽  
Houssem Thabet ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Transthoracic Echocardiography ◽  
Right Atrium ◽  
Benign Tumors ◽  
Histopathological Analysis ◽  
Tricuspid Valve Repair ◽  
Flow Measurements ◽  
Surgical Specimen ◽  
Eosinophilic Cytoplasm ◽  
The Right

Abstract Background Cardiac Hibernomas are very rare benign tumors and usually remain asymptomatic. Neonatal cardiogenic shock due to cardiac tumors is extremely very rare. Until this date a few cases of cardiac hibernoma have been reported in the literature. Transthoracic echocardiography help in the differential diagnosis, but the definitive diagnosis is histological. The management strategy is not clearly codified. The Aim is to report and discuss the clinical features of a cardiac Hibernoma and review the relevant literature. Case presentation We describe a case of a 2-day-old Caucasian full-term male neonate admitted in neonate intensive care with cardiogenic shock, having fluid resuscitation and inotropic drugs. Ventilatory support was started immediately with the subsequent reestablishment of normal blood pressure. Then he was transferred to the echocardiography laboratory. Transthoracic echocardiography showed two echogenic masses in the right atrium and right ventricle. The masses were extended to the pulmonary trunk. Pulmonary artery flow measurements showed the presence of pulmonary and tricuspid obstruction. Surgery was rapidly considered since the baby was hemodynamically unstable. Intraoperative evaluation showed a mass embedded in the interventricular septum that occupy the right ventricular cavity and the right atrium. The tumor involved also the chordae of the tricuspid. Partial resection was done. Tricuspid valve repair was performed by construction of new chordae from the autologous pericardium. The specimen was sent for histopathological analysis. The baby died immediately after surgery. Histological examination of the surgical specimen revealed clear multivacuolated cells filled with lipid droplets and granular intense eosinophilic cytoplasm which confirms the diagnosis of Hibernoma. Conclusion Cardiac Hibernomas are rare benign tumors. The prognosis and treatment strategy is closely dependent on the location, initial clinical presentation and possible complications. The prognosis can be unfavorable if the tumor was obstructive and infiltrate the myocardium.

scholarly journals P854 The role of multimodality imaging in revealing a rare cause of persistent ascites

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A M Buburuz ◽  
D T M Marcu ◽  
I Demsa ◽  
G Tinica ◽  
A Petris ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Right Atrium ◽  
Multimodality Imaging ◽  
Cardiac Myxoma ◽  
Right Atrial ◽  
Benign Tumors ◽  
Cardiac Tumors ◽  
Tumor Type ◽  
The Right

Abstract Primary cardiac tumors are very rare causes of intracavitary masses, about 5% of all cardiac tumors. Most of them are benign tumors, and 50% are represented by atrial myxomas. They are usually developed in the left atrium, with a pedicle attached to the interatrial septum. Cardiac myxomas are one of the "greatest mimes" of pathology, with a polymorphic clinical presentation, from obstructive, to embolic and constitutional clinical manifestation. We present the case of a 58-year-old female patient with 4 years history of chronic obstructive pulmonary disease (COPD), on bronchodilator treatment and long-term oxygen therapy. She accused two months duration of abdominal distension due to ascites, for which she was evaluated in the gastroenterology department and received diuretics association. The symptoms were refractory to the treatment, so the patient was referred for cardiovascular examination. At presentation, the patient was afebrile, with a heart rate of 100/minute, blood pressure was 125/90 mmHg. Cardiovascular examination did not reveal any murmurs, jugular venous distension was present. 12-lead electrocardiogram (ECG): sinus rhythm, with right atrial enlargement. The transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) revealed a lobulated giant mass in RA, which occupied almost the entire cavity, with prolapse towards the right ventricle during diastole. Due to the large intracavitary mass, the point of attachment could not be ascertained. Computed tomography (CT) of the thorax was performed and it confirmed the presence of the giant right cardiac mass. The patient underwent surgical excision of the tumor under cardiopulmonary bypass. Intraoperative findings were represented by a yellowish-brown lobulated friable mass in the right atrium cavity, measuring 70/30/35 mm. The pedicle of the tumor was inserted on the free wall of the right atrium. The histopathological examination revealed round to stellate cells in a myxoid stroma, specific for cardiac myxoma. Postoperative evolution was influenced by the severe pulmonary disease, with prolonged mechanical ventilation and positive inotropic support, but it was slowly favorable, and the patient was discharged in good condition. Right atrial myxoma is a very rare intracardiac tumor with nonspecific forms of clinical presentations, that create difficulties in diagnosis. Ascites represents an unusual form of manifestation in a patient with a cardiac tumor. The insertion of the pedicle of the myxoma was atypical and induced difficulties in early evaluation of the tumor type. Even though myxomas are mainly benign tumors, the complication rate is very high, especially of embolic events due to the friable tumoral mass, so they can become life threatening conditions. Early diagnosis of cardiac myxoma based on multimodality imaging is essential, leading to optimal surgical management, with good long-term survival. Abstract P854 Figure. TEE view of giant RA tumor

Cor triatriatum dexter masquerading as Ebstein's anomaly

2011 ◽  
Vol 21 (3) ◽  
pp. 354-356 ◽  
Author(s):  
Souheir Salam ◽  
David Gallacher ◽  
Orhan Uzun
Keyword(s):  
Tricuspid Valve ◽  
Transthoracic Echocardiography ◽  
Right Atrium ◽  
Cor Triatriatum ◽  
Ebstein’S Anomaly ◽  
Ebstein's Anomaly ◽  
Cor Triatriatum Dexter ◽  
The Right

AbstractWe report the case of a child with cor triatriatum dexter masquerading as Ebstein's anomaly on transthoracic echocardiography. This was attributed to a floppy membrane arising from the right atrium, protruding into the tricuspid valve and pushing the leaflets downwards, giving an impression of Ebstein's anomaly. The importance of recognising this pitfall will prevent misdiagnosis of Ebstein's anomaly.

scholarly journals Cardiac Lipoma - Case presentation

2021 ◽  
Vol 107 (05) ◽  
pp. 240-242
Author(s):  
Ása Unnur Bergmann ◽  
◽  
Helga Þórunn Óttarsdóttir ◽  
Björn Flygenring ◽  
Helgi Már Jónsson ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Right Atrium ◽  
Clinical Symptoms ◽  
Incidental Finding ◽  
Superior Vena ◽  
Vena Cava ◽  
Large Mass ◽  
Benign Tumors ◽  
Computed Tomographic ◽  
The Right

Cardiac lipomas are very rare benign tumors of the heart. They are usually asymptomatic and are often an incidental finding on cardiac imaging. This case report involves an 82-year-old female with a history of diabetes admitted because of poor glycemic control. An echocardiogram requested because of arrhythmias and heart failure revealed a tumor in the right atrium. Computed tomographic and ultrasound appearances were consistent with a lipoma and demonstrated a large mass in the right atrium, causing a significant stenosis of the superior vena cava but no clinical symptoms or signs of superior vena cava syndrome

scholarly journals Uterine intravenous leiomyomatosis with an isolated large metastasis to the right atrium: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Mitsutake Yano ◽  
Tomomi Katoh ◽  
Yoshie Nakajima ◽  
Shiro Iwanaga ◽  
Rei Kin ◽  
...  
Keyword(s):  
Right Atrium ◽  
Lower Abdominal Pain ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Japanese Woman ◽  
Right Atrial ◽  
Medical Attention ◽  
Intravenous Leiomyomatosis ◽  
Eosinophilic Cytoplasm ◽  
The Right

Abstract Background An intravenous leiomyomatosis is a special type of uterine leiomyoma characterized by the formation of benign leiomyomatous tissue within the vascular wall. Although histologically benign, intracardiac metastasis can lead to circulatory failure, and death, if untreated. Herein, we report on a case of a uterine intravenous leiomyomatosis with an isolated large adherent metastasis in the right atrium of the heart. Case Presentation A 52-year-old Japanese woman sought medical attention at our hospital for lower abdominal pain. A 27-cm uterine mass was detected on clinical imaging, with a 78 × 47-mm mass in the right atrium detected on preoperative echocardiography. Intracardiac mass resection and tricuspid annuloplasty were performed as the first-stage surgery. The pedicle of the tumor was adherent to the wall of the atrium. On histological examination, the tumor was found to consist of spindle-shaped cells with eosinophilic cytoplasm, without atypia, but with a myxoid change, and rich microvascularization of the pedicle. Total abdominal hysterectomy was performed as the second-stage surgery, with confirmation of the diagnosis as uterine intravenous leiomyomatosis with an isolated metastasic lesion to the right atrium. There has been no evidence of tumor recurrence in the 15 months since surgery. Conclusion We report a unique case in which a large right atrial leiomyoma was identified following a uterine intravenous leiomyomatosis. Our case exemplifies that intravenous leiomyomatosis metastatic tumors have the potential to grow via their vascularization.

scholarly journals Local Recurrence of Primary Cardiac Leiomyosarcoma After Resection: A Rare Case

2021 ◽  
Vol 15 (4) ◽  
pp. 223
Author(s):  
Fatih TAY ◽  
Mustafa Büyükkör ◽  
Öztürk Ateş
Keyword(s):  
Local Recurrence ◽  
Transthoracic Echocardiography ◽  
Right Atrium ◽  
Medical Management ◽  
Rare Case ◽  
Systemic Chemotherapy ◽  
Chemotherapy Treatment ◽  
Recurrence Rates ◽  
Treatment Plans ◽  
The Right

Introduction: Leiomyosarcoma (LMS) is a fatal tumor, though primary cardiac is very rarely encountered. In this report, we evaluated the surgical and medical management of primary cardiac LMS, which is a sporadic tumor.Case Presentation: A 60-year-old female patient was examined for pulmonary edema after penicillin allergy in May 2019, while transthoracic echocardiography (ECHO) revealed an appearance compatible with a 5x3.5 cm mass in the right atrium. In addition, transesophageal ECHO showed a 7x4.6 cm foreground mass compatible with a myxoma in the right atrium (RA). The patient was then operated on emergency. Besides, an adjuvant ifosfamide-mesna-doxorubicine (IMA) protocol was planned to be given to the patient after local radiotherapy.Conclusions: In this report presented, we made RT and chemotherapy treatment plans in the case of recurrence without R0 surgery. Recurrence rates of up to 50% can occur in LMS, and systemic chemotherapy can be applied after relapse

scholarly journals 179 ICD or not ICD? A difficult choice for a young patient presenting with palpitations in emergency department

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Maria Teresa Savo ◽  
Elisa Balducci ◽  
Vittorio Calzolari ◽  
Carlo Cernetti
Keyword(s):  
Emergency Department ◽  
Sinus Rhythm ◽  
Transthoracic Echocardiography ◽  
Cardiac Mri ◽  
Right Atrium ◽  
Heart Surgery ◽  
Systolic Dysfunction ◽  
End Diastolic Volume ◽  
Wave Inversion ◽  
The Right

Abstract A fit-and-well 52-year-old worker, with negative familiar story, was admitted to Emergency Department (ED) with haemodynamically unstable but well bore broad complex tachycardia of 180 b.p.m. (Figure 1). Twenty years before the patient had heart-surgery to repair atrial septal venous sinus defect with patch. The defect determined anomalous pulmonary venous return in right atrium with left to right shunt and moderate pulmonary hypertension. The surgery, 20 years before, was complicated by a single event of supraventricular tachycardia pharmacology resolved. Next follow-up was normal although at transthoracic echocardiography severe right ventricular (RV) dilation was reported. In the ED the patient had palpitation but not chest pain or dyspnoea. General clinical examination was normal but he was hypertensive (170/137 mmHg) and with heart rate of 180 b.p.m. Valsalva manoeuver was performed and adenosine (6 mg–12 mg–12 mg) was administered without benefit. Eventually, the patient was cardioverted to sinus rhythm with a single 100 J shock. His baseline ECG (Figure 2) showed sinus rhythm, normal axis, as well as right bundle branch block and T-wave inversion in leads V1–V4 and a waves with a small spike upward in lead V1 which represent characteristic epsilon waves. Successively patient was admitted to Cardiology Department where transthoracic echocardiography showed severe RV dilation and moderate hypokinesia with a tricuspid annular plane excursion of 15 mm, TAV 9.6 cm/s, fractional area change of 29%. The right atrium was moderate dilated (volume 70 ml, indexed volume 35.53 ml/m2). Left chambers were normal. No shunts were observed. An electrophysiology study with isoprenaline infusion was performed but no arrhythmias were induced. Cardiac magnetic resonance imaging (MRI) was normal save for global RV dilatation, increased RV end diastolic volume (156 ml/m2), and global RV systolic dysfunction (reduction of RV ejection fraction 31%). Arrhythmogenic cardiomyopathy was excluded as patient’s background suggested RV dilation was due the overload caused by the history of left–right shunt. Blood tests and personal history negative initially exclude myocarditis and cardiac MRI confirmed the absence of oedema. An accurate ECG analysis excluded Brugada syndrome. Following discussion between electrophysiologists, clinical cardiologists, and the patient who first need to be informed, trans-venous ICD was implanted. 179 Figure 1ECG in ED.               Figure 2 Baseline ECG.                 Figure 3 Cardiac MRI.

scholarly journals A Rare Case of Angiofibroma Mimicking Fibrous Epulis in Posterior Gingival Mucosa

2021 ◽  
Vol 55 (8) ◽  
Author(s):  
Annete Nabila ◽  
Ni Putu Mira Sumarta ◽  
Okky Prasetio
Keyword(s):  
Rare Case ◽  
Histopathological Examination ◽  
Excisional Biopsy ◽  
Definitive Diagnosis ◽  
Benign Tumors ◽  
Histopathological Analysis ◽  
Clinical Appearance ◽  
Gingival Mucosa ◽  
The Right ◽  
Superficial Soft Tissue

Angiofibromas are highly vascular, locally aggressive but histologically benign tumors. A 40-year-old woman complaint of pedunculated mass in the right gingiva of the posterior region since 7 months earlier. Surgical excisional biopsy under general anesthesia was performed. Histopathological examination showed an angiofibroma. Angiofibromas are localized in the superficial soft tissue and the gingiva could have a similar clinical appearance as an epulis. Definitive diagnosis was determined through histopathological analysis.

scholarly journals Massive right atrial myxoma with dyspnea at rest in an elderly patient: A case report

2015 ◽  
Vol 72 (3) ◽  
pp. 291-294 ◽  
Author(s):  
Radoslav Romanovic ◽  
Nenad Ratkovic ◽  
Zaklina Davicevic ◽  
Radoje Ilic
Keyword(s):  
Case Report ◽  
Pericardial Effusion ◽  
Transthoracic Echocardiography ◽  
Right Atrium ◽  
Body Weight Loss ◽  
Right Atrial ◽  
Surgical Removal ◽  
Right Atrial Myxoma ◽  
Heart Tumors ◽  
The Right

Introduction. Primary heart tumors are extremely rare and myxoma is the most common type of these tumors. Although intraatrial presentation is a predilection place, right atrial localization is atypical. The symptom triad is characteristic in the clinical presentation of the tumor: embolic complication, intracardiac blood flow obstruction and systemic manifestations like elevated erythrocyte sedimentation rate, fever, anemia, body weight loss. Case report. We presented an elderly female patient with massive myxoma in the right atrium, 77 ? 44 mm in diameter, which filled the entire right atrium and spread into the right ventricle, causing the tricuspid valve obstruction and dyspnea. It was visualized by transthoracic echocardiography and small and insignificant pericardial effusion was also seen. After surgical removal of the tumor, the patient remained without any symptoms and pericardial effusion. Conclusion. Tumors of the right heart have to be considered in the differential diagnosis of unexplained dyspnea in elderly patients. Transthoracic echocardiography is certainly necessary and mostly available diagnostic tool that can be of great help in diagnosing heart tumor as well as planning cardiac surgery, as it provides in most cases excellent visualization of the tumor and its relationship with other parts of the heart.

scholarly journals An unexpected cause of sepsis in a patient with dental decay (Answers)

2013 ◽  
Vol 12 (1) ◽  
pp. 59-61
Author(s):  
Rob LJ Zwinkels ◽  
◽  
Simone van der Sar – van der Brugge ◽  
Steven J Sleeswijk Visser ◽  
◽  
...  
Keyword(s):  
Left Atrium ◽  
Ct Angiography ◽  
Transthoracic Echocardiography ◽  
Right Atrium ◽  
Dental Decay ◽  
Vascular Abnormalities ◽  
Intracardiac Mass ◽  
Tricuspid Insufficiency ◽  
The Right

The patient underwent transthoracic echocardiography which confirmed the presence of a calcified intracardiac mass in the right atrium, with significant tricuspid insufficiency and compression of the left atrium (Figure 2). CT angiography of the thorax revealed the tumour was 7.2×5.3×4.4 cm. Initially, no pulmonary vascular abnormalities were seen.

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