Use of microbubble contrast in the diagnosis of a left ventricular papillary fibroelastoma

SummaryA papillary fibroelastoma is a rare, avascular, cardiac tumour that is often found incidentally using transthoracic echocardiography (TTE). Peripheral i.v. injection of a microbubble contrast agent is often used to characterize abnormal masses within the heart allowing further delineation of physical features, the area of attachment, and vascularity of the mass in order to differentiate the growth from a tumour or a thrombus. This case highlights a potential pitfall when assessing a cardiac tumour's vascularity using contrast TTE. A cardiac mass was identified on a TTE of a 53-year-old man and was further investigated with microbubble contrast-enhanced TTE. Contrast TTE imaging suggested a vascularized structure in the left ventricle. However, after histological examination the tumour was found to be entirely avascular.Learning pointsDifferentiation of cardiac tumour is usually best performed with contrast echocardiography.Contrast echocardiography may not be best tool to determine if cardiac mass is vascularized.A papillary fibroelastoma can appear vascularized with contrast echocardiography due to it's frond-like structures.Physicians should be aware of this potential confusion when assessing a cardiac tumour in patients.

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Myocardial contrast echocardiography in the diagnosis of a left ventricular hemangioma

Italian Journal of Medicine ◽

10.4081/itjm.2016.618 ◽

2016 ◽

Vol 10 (2) ◽

pp. 151

Author(s):

Kyriacos Papadopoulos ◽

Constantinos Makrides

Keyword(s):

Myocardial Perfusion ◽

Transthoracic Echocardiography ◽

Contrast Echocardiography ◽

Left Ventricular ◽

Cardiac Mass ◽

Cardiac Tumors ◽

Final Report ◽

Imaging Tool ◽

Hypervascular Tumor ◽

Primary Cardiac Tumors

Myocardial perfusion contrast echocardiography is an imaging tool for the assessment of myocardial microcirculation. It can also be used for the evaluation of the relative perfusion of a cardiac mass. Cardiac hemangiomas are rare tumors, accounting for only 2.8% of all benign primary cardiac tumors. We report a case of a 17-year-old man with a left ventricular hemangioma detected with transthoracic echocardiography. Myocardial perfusion contrast echocardiography was used to evaluate the vascularity of the cardiac mass. Using this technique malignant and hypervascular (<em>e.g</em>., hemangioma) tumors display persistence of contrast enhancement compared to the surrounding myocardium. The mass was successfully removed and the final report from pathology showed that the left ventricular mass was a hemangioma, a hypervascular tumor

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Diagnostic computed tomography in acute interscapular pain

Heart ◽

10.1136/heartjnl-2019-315821 ◽

2019 ◽

Vol 106 (2) ◽

pp. 126-163

Author(s):

Shruti S Joshi ◽

Mardi Hamra ◽

David E Newby

Keyword(s):

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Venous Pressure ◽

Sudden Onset ◽

Acute Onset ◽

Left Ventricular ◽

List Type ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

Clinical introductionA man in his 60s with no medical history presented with sudden-onset, severe interscapular pain. He was in circulatory shock with a blood pressure of 65/30 mm Hg, heart rate of 115 beats per minute, respiratory rate of 32 breaths per minute and a room air oxygen saturation of 89%. Examination demonstrated weak peripheral pulses, an elevated jugular venous pressure, faint dual heart sounds, no cardiac murmurs and bilateral lung crepitations. An ECG was recorded which showed a broad QRS (figure 1A). There were no previous ECGs to compare this with. In view of his presentation with acute-onset interscapular pain, CT of the aorta was organised by the emergency department clinicians (figure 1B–D). After the CT result was obtained, the on-call cardiologist was contacted and a bedside echocardiogram performed. This demonstrated severe left ventricular systolic dysfunction with akinesia of the apex and lateral walls. The patient was then transferred to the catheter laboratory for an emergency invasive coronary angiogram.Figure 1ECG and CT images at presentation (A) 12 lead ECG. (B) Contrast enhanced CT aorta - coronal view. (C) Contrast enhanced CT aorta - axial view. (D) CT aorta showing 4 chamber view of the heart.What is the most likely diagnosis?Pulmonary embolism.Aortic dissection.Acute myocardial infarction.Cardiac tamponade.

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A case of hepatopulmonary syndrome

Echo Research and Practice ◽

10.1530/erp-14-0100 ◽

2015 ◽

Vol 2 (2) ◽

pp. K25-K27 ◽

Cited By ~ 6

Author(s):

James Offer ◽

Lawrence Green ◽

Andrew R Houghton ◽

Jim Campbell

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Contrast Echocardiography ◽

Hepatopulmonary Syndrome ◽

List Type ◽

Left Heart ◽

Key Features ◽

Inexpensive Procedure ◽

Learning Points ◽

Contrast Studies

SummaryThis report presents the case of a 42-year-old man with liver cirrhosis who presents with breathlessness. Initial investigations are unable to explain his persistent hypoxia and a diagnosis of hepatopulmonary syndrome is considered. Saline contrast echocardiography is utilised in confirming the diagnosis. Details of this case as well as practicalities in performing and interpreting saline contrast echocardiography are reviewed.Learning pointsKey features of hepatopulmonary syndrome are liver disease, hypoxia and pulmonary vascular dilatations.Saline contrast echocardiography is a simple inexpensive procedure to perform and key to confirming the diagnosis of hepatopulmonary syndrome. Detection can be improved by performing the scan in the stand-up position.Agitated saline contrast studies are more commonly performed to identify intra-cardiac shunts. Timing of contrast arrival in the left heart chambers is key to differentiating intra-cardiac shunting from extra-cardiac pulmonary transit.

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Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

Texas Heart Institute Journal ◽

10.14503/thij-14-4447 ◽

2015 ◽

Vol 42 (5) ◽

pp. 474-478 ◽

Cited By ~ 1

Author(s):

Toshimasa Okabe ◽

Howard M. Julien ◽

Antony G. Kaliyadan ◽

Henry Siu ◽

Gregary D. Marhefka

Keyword(s):

Cardiac Tamponade ◽

Contrast Echocardiography ◽

Open Heart Surgery ◽

Pulseless Electrical Activity ◽

Left Ventricular ◽

Ventricular Free Wall ◽

Free Wall ◽

Left Ventricular Free Wall ◽

Free Wall Rupture ◽

Contrast Enhanced

In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment.

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Catastrophic stroke in a patient with left ventricular non-compaction

Echo Research and Practice ◽

10.1530/erp-18-0015 ◽

2018 ◽

Vol 5 (3) ◽

pp. K59-K62 ◽

Cited By ~ 3

Author(s):

Sothinathan Gurunathan ◽

Roxy Senior

Keyword(s):

Left Ventricular ◽

List Type ◽

Colour Doppler ◽

Mortality And Morbidity ◽

History Of ◽

Dimensional Echocardiography ◽

Two Dimensional Echocardiography ◽

Learning Points ◽

Normal Cardiac Function

Summary We present the case of a 32-year-old man who presented with a remote history of chest pain and was diagnosed with non-compaction cardiomyopathy on echocardiography. On presentation, he was relatively asymptomatic with normal cardiac function. Unfortunately, he presented 1 year later with a catastrophic embolic stroke. Learning points: Left ventricular non-compaction (LVNC) is a myocardial disorder characterised by prominent left ventricular (LV) trabeculae, a thin compacted layer and deep intertrabecular recesses. Two-dimensional echocardiography with colour Doppler is the study of choice for diagnosis and follow-up of LVNC. CMR serves an important role where adequate echocardiographic imaging cannot be obtained. LVNC is associated with high rates of mortality and morbidity in adults, including heart failure, thromboembolic events and tachyarrhythmias.

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