scholarly journals Lung Cancer That Extended to the Left Atrium Through the Pulmonary Vein: A Case Report

Author(s):  
Xin Xu ◽  
Ping Xu ◽  
Ting Ting Wu ◽  
Guo Dong Shang

Abstract Background: Metastatic cardiac tumors have been reported in up to 25% of patients with lung cancer, but detection of cardiac involvement via pulmonary veins is neither uncommon nor easy in the routine work. Case presentation: A 68-year-old woman with primary lung cancer was admitted to the hospital with pain in her left leg for 6 months and hemoptysis for one week. TTE detected that a hyperechoic mass in the left atrium which was come from the left inferior pulmonary vein. The result was confirmed by computed tomography.Conclusions: Multimodality imaging should be advocated in the evaluation of cardiac masses especially for patient who has primary tumors.

Author(s):  
Alan G Dawson ◽  
Cathy J Richards ◽  
Leonidas Hadjinikolaou ◽  
Apostolos Nakas

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.


2009 ◽  
Vol 297 (1) ◽  
pp. H102-H108 ◽  
Author(s):  
Nicolas Doisne ◽  
Véronique Maupoil ◽  
Pierre Cosnay ◽  
Ian Findlay

Ectopic activity in cardiac muscle within pulmonary veins (PVs) is associated with the onset and the maintenance of atrial fibrillation in humans. The mechanism underlying this ectopic activity is unknown. Here we investigate automatic activity generated by catecholaminergic stimulation in the rat PV. Intracellular microelectrodes were used to record electrical activity in isolated strips of rat PV and left atrium (LA). The resting cardiac muscle membrane potential was lower in PV [−70 ± 1 (SE) mV, n = 8] than in LA (−85 ± 1 mV, n = 8). No spontaneous activity was recorded in PV or LA under basal conditions. Norepinephrine (10−5 M) induced first a hyperpolarization (−8 ± 1 mV in PV, −3 ± 1 mV in LA, n = 8 for both) then a slowly developing depolarization (+21 ± 2 mV after 15 min in PV, +1 ± 2 mV in LA) of the resting membrane potential. Automatic activity occurred only in PV; it was triggered at approximately −50 mV, and it occurred as repetitive bursts of slow action potentials. The diastolic membrane potential increased during a burst and slowly depolarized between bursts. Automatic activity in the PV was blocked by either atenolol or prazosine, and it could be generated with a mixture of cirazoline and isoprenaline. In both tissues, cirazoline (10−6 M) induced a depolarization (+37 ± 2 mV in PV, n = 5; +5 ± 1 mV in LA, n = 5), and isoprenaline (10−7 M) evoked a hyperpolarization (−11 ± 3 mV in PV, n = 7; −3 ± 1 mV in LA, n = 6). The differences in membrane potential and reaction to adrenergic stimulation lead to automatic electrical activity occurring specifically in cardiac muscle in the PV.


2018 ◽  
Vol 22 (4) ◽  
Author(s):  
Beata Kucińska ◽  
Bożena Werner

The increase in the availability of transthoracic echocardiography allows the diagnosis of not only congenital heart defects, which are the most common congenital defects in children, but also detection of cardiac masses such as thrombi, vegetations or heart tumors. Performing transthoracic echocardiography one should remember about normal anatomical structures in the atria and ventricles. The presence of central catheters and intracardiac leads favors the formation of thrombi in the heart. The vegetations which are characteristic for infective endocarditis mostly occur on the aortic and/or mitral valve. Primary cardiac tumors in children are very rare (approximately 0.2% of the population) and are usually oligosymptomatic. About 90% of them are benign tumors. The most common is the rhabdomyoma, which often coexists with tuberous sclerosis. The second most frequent tumor in children is a fibroma. Less common primary tumors in children are: teratomas, hemangiomas, lipomas, papillary fibroelastomas. In the differential diagnosis of cardiac masses comprehensive assessment and analysis of both imaging results, as well as medical history, physical examination, laboratory tests and other additional tests are extremely important.


Heart ◽  
2021 ◽  
pp. heartjnl-2021-319334
Author(s):  
Jay Relan ◽  
Saurabh Kumar Gupta ◽  
Rengarajan Rajagopal ◽  
Sivasubramanian Ramakrishnan ◽  
Gurpreet Singh Gulati ◽  
...  

ObjectivesWe sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography.MethodsCT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed.ResultsThe median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients.ConclusionAnomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.


2020 ◽  
Vol 22 (12) ◽  
Author(s):  
Rossana Bussani ◽  
Matteo Castrichini ◽  
Luca Restivo ◽  
Enrico Fabris ◽  
Aldostefano Porcari ◽  
...  

Abstract Purpose of Review Cardiac masses frequently present significant diagnostic and therapeutic clinical challenges and encompass a broad set of lesions that can be either neoplastic or non-neoplastic. We sought to provide an overview of cardiac tumors using a cardiac chamber prevalence approach and providing epidemiology, imaging, histopathology, diagnostic workup, treatment, and prognoses of cardiac tumors. Recent Findings Cardiac tumors are rare but remain an important component of cardio-oncology practice. Over the past decade, the advances in imaging techniques have enabled a noninvasive diagnosis in many cases. Indeed, imaging modalities such as cardiac magnetic resonance, computed tomography, and positron emission tomography are important tools for diagnosing and characterizing the lesions. Although an epidemiological and multimodality imaging approach is useful, the definite diagnosis requires histologic examination in challenging scenarios, and histopathological characterization remains the diagnostic gold standard. Summary A comprehensive clinical and multimodality imaging evaluation of cardiac tumors is fundamental to obtain a proper differential diagnosis, but histopathology is necessary to reach the final diagnosis and subsequent clinical management.


EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A P Martin ◽  
M Fowler ◽  
N Lever

Abstract Background Pulmonary vein isolation using cryotherapy is an established treatment for the management of patients with paroxysmal atrial fibrillation. Ablation using the commercially available balloon cryocatheter has been shown to create wide antral pulmonary vein isolation. A novel balloon cryocatheter (BCC) has been designed to maintain uniform pressure and size during ablation, potentially improving contact with the antral anatomy. The extent of ablation created using the novel BCC has not previously been established. Purpose To determine the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing catheter ablation for paroxysmal atrial fibrillation using the novel BCC. Methods Nine consecutive patients underwent pre-procedure computed tomography angiography of the left atrium to quantify the chamber dimensions. An electroanatomical map was created using the cryoablation system mapping catheter and a high definition mapping system. A bipolar voltage map was obtained following ablation to determine the extent of pulmonary vein isolation ablation. A volumetric technique was used to quantify the extent of vein and posterior wall electrical isolation in addition to traditional techniques for proving entrance and exit block. Results All patients had paroxysmal atrial fibrillation, mean age 56 years, 7 (78%) male. Electrical isolation was achieved for 100% of the pulmonary veins; mean total procedure time was 109 min (+/- 26 SD), and fluoroscopy time 14.9 min (+/- 2.4 SD). The median treatment applications per vein was one (range one - four), and median treatment duration 180 sec (range 180 -240). Left atrial volume 32 mL/m2 (+/- 7 SD), and mean left atrial posterior wall area 22 cm2 (+/- 4 SD). Data was available for quantitative assessment of the extent of ablation for eight patients. No lesions (0 of 32) were ostial in nature. The antral surface area of ablation was not statistically different between the left and right sided pulmonary veins (p 0.63), which were 5.9 (1.6 SD) and 5.4 (2.1 SD) cm2 respectively. In total 50% of the posterior left atrial wall was ablated.  Conclusion Pulmonary vein isolation using a novel BCC provides a wide and antral lesion set. There is significant debulking of the posterior wall of the left atrium. Abstract Figure.


Surgery Today ◽  
2020 ◽  
Author(s):  
Koji Kuroda ◽  
Masataka Mori ◽  
Syuichi Shinohara ◽  
Rintaro Oyama ◽  
Hiroki Matsumiya ◽  
...  

2007 ◽  
Vol 189 (2) ◽  
pp. 386-392 ◽  
Author(s):  
Chin A Yi ◽  
Tae Yeon Jeon ◽  
Kyung Soo Lee ◽  
Jung Hee Lee ◽  
Joon Beom Seo ◽  
...  

2001 ◽  
Vol 11 (6) ◽  
pp. 632-642 ◽  
Author(s):  
Sandra Webb ◽  
Mazyar Kanani ◽  
Robert H. Anderson ◽  
Michael K. Richardson ◽  
Nigel A. Brown

Objective: Using a newly acquired archive of previously prepared material, we sought to re-examine the origin of the pulmonary vein in the human heart, aiming to determine whether it originates from the systemic venous sinus (“sinus venosus”), or appears as a new structure draining to the left atrium. In addition, we examined the temporal sequence of incorporation of the initially solitary pulmonary vein to the stage at which four venous orifices opened to the left atrium. Methods: We studied 26 normal human embryos, ranging from 3.8 mm to 112 mm crown-rump length, and representing the period from the 12th Carnegie stage to 15 weeks of gestation. Results: The pulmonary vein canalised as a solitary vessel within the mediastinal tissues so as to connect the intraparenchymal pulmonary venous networks to the heart, using the regressing dorsal mesocardium as its portal of cardiac entry. The vein was always distinct from the tributaries of the embryonic systemic venous sinus. The orifice of the solitary vein became committed to the left atrium by growth of the vestibular spine. During development, a marked disparity was seen between the temporal and morphological patterns of incorporation of the left-sided and right-sided veins into the left atrium. The pattern of the primary bifurcation was asymmetrical, a much longer tributary being formed on the left than on the right. Contact between the atrial wall and the venous tributary on the left initially produced a shelf, which became effaced with incorporation of the two left-sided veins into the atrium. Conclusions: The initial process of formation of the human pulmonary vein is very similar to that seen in animal models. The walls of the initially solitary vein in humans become incorporated by a morphologically asymmetric process so that four pulmonary veins eventually drain independently into the left atrium. Failure of incorporation on the left side may provide the substrate for congenital division of the left atrium.


2016 ◽  
Vol 4 (2) ◽  
pp. 74-78
Author(s):  
Elizabeth Ungerman ◽  
Wendy Haft

ABSTRACT Most cardiac tumors are benign myxomas, and are most commonly found in the left atrium. Such tumors are identified either during symptomatic workup or found incidentally. We present a case in which a patient with recurrent transient ischemic attacks and syncope was found to have a giant right atrial myxoma with subsequent right atrial outflow obstruction. The mass was initially diagnosed on transthoracic echocardiography and its full scope was detailed utilizing transesophageal echocardiography (TEE). With swift intervention, the mass was successfully removed with the help of TEE guidance and the patient made a full recovery. The importance of TEE both preoperatively and intraoperatively during resection of giant cardiac masses is highlighted. How to cite this article Ungerman E, Haft W. Giant Right Atrial Myxoma: The Importance of Transesophageal Echocardiography during Diagnosis, Evaluation, and Resection. J Perioper Echocardiogr 2016;4(2):74-78.


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