Intracardiac Mass Detection and Classification Using Double Convolutional Neural Network Classifier

Intracardiac masses identification in the images of echocardiogram images in one of the most essential tasks in making the diagnosis of cardiac disease. For making the improvement in accuracy over the diagnosis as a new complete method of classifying the echocardiogram images automatically which is based on robust back propagation neural network algorithm in being proposed for distinguishing intracardiac thrombi and tumor. Initially, the cropping over the specific region is done in order to make the definition of the mass area. Later on, as the second step the processing of globally unique denoising technique is being implied for the removal of speckle and in order to make the preservation of anatomical structured component in the image. This is defined in terms of preprocessing and it is carried out by Patch-based sparse representation. Subsequently the description of the mass contour and its interconnected wall of the artery are being done by the segmentation mechanism denoted as Linear Iterative Vessel Segmentation model. As the prefinal stage, the processing of boundary, texture and the motion features are being carried out through the processing by double convolutional neural network (DCNN) classifier in order to determine the classification of two different masses. Totally 108 cardiac masses images are being collected for accessing the effectiveness of the classifier. It is also realized with the various state of the art classifiers as projected the demonstration of the greatest performance that has been disclosed with an achievement of 98.98% of accuracy, 98.89% of sensitivity and 99.16% of specificity that has been resulted for DCNN classifier. It determines the explication that the proposed method is capable of performing the classification of intracardiac thrombi and tumors in the echocardiography and ensures for potentially assisting the medical doctors who are in the clinical practice.

Urgent excision of primary intracardiac Burkitt Lymphoma in a child

We present the case of a 9-year-old girl who was referred to our service with a recent history of shortness of breath on exertion and fatigue in addition to visual disturbances and gastrointestinal symptoms. A Transthoracic Echocardiography demonstrated the presence of 3 large intracardiac masses in both the right and left atrium protruding into the mitral and tricuspid valve orifices causing bilateral inflow obstruction. The patient underwent urgent surgical excision of the masses which was uncomplicated. Histological testing was consistent with a rare intracardiac location of Burkitt’s Lymphoma.

ECHOGENIC MASS ATTACHED TO TRICUSPID VALVE

SUMMARY A 5-day old female child with complaints of tachypnea, had TTE which revealed an echogenic mass on septal leaflet of Tricuspid valve. Based on echocardiographic features, it was diagnosed as Papillary fibroelastoma. CASE DESCRIPTION A 5-day old female child was referred for transthoracic echocardiographic study due to respiratory difficulty. The child was afebrile and had a respiratory rate of 60/min, heart rate 130 bpm, and blood pressure 80/50 mmHg. No murmur or added sound heard on CVS examination. TTE revealed a dense mass (Figure 1) attached to right atrial side of septal leaflet of Tricuspid valve by a small pedicle. The mass was mobile, prolapsing into right ventricle during diastole (Clips) without causing obstruction with size of 0.8 X 0.74 cm. Intracardiac masses attached to valves are usually Papillary fibroelastomas. Other possible differential diagnoses could be myxoma, vegetation, Lambl’s excrescence or secondary tumors etc. Based on the location and echo features of the mass (mobility, attachment to downstream side of valve, and frond like speckled appearance) the diagnosis of Papillary fibroelastoma was made. LEARNING POINTS Cardiac tumors are rare and mostly benign. The three most common primary tumors of heart, in order of frequency, are myxomas, lipomas and papillary fibroelastomas respectively. PFE constitute 7% - 9% of all.1 PFE usually arise from valves of the heart and are mostly left-sided.2 They are mobile, range from 0.5 – 2 cm in size and have a frond-like appearance. On echo, they are dense with a speckled interior and shimmering surface.3 Being prone to embolization and thrombosis, their clinical course may not be benign, especially left sided. Clips Subcostal Clip: https://youtu.be/_xTZmx--WcA PS SAX View: https://youtu.be/lLh6D9Vn4Fw A4C View: https://youtu.be/_xZZvTIh0S8 A4C RV Directed View: https://youtu.be/vJRyHrevftA QUESTIONS WITH ANSWERS Question 1: What is the most common complication of papillary fibroelastoma? Question 2: The behavior of right and left sided papillary fibroelastomas could be markedly different, Y/N? Question 3: What is the most important feature of papillary fibroelastoma for embolization? Question 4: PFE preferentially affects females, Y/N? Answers Question 1: Cerebral embolism Question 2: Yes Question 3: Mobility Question 4: No References Bouhzam N, Kurtz B, Doguet F, Eltchaninoff H, Bauer F. Incidental papillary fibroelastoma multimodal: imaging and surgical decisions in 2 patients. Tex Heart Inst J. 2012;39(5):731-5. Eidem BW, Cetta F, O’ Leary PW. Echocardiography in pediatric and adult congenital heart disease. Lippincott, Williams and Wilkins, Wolters Kluwer. 2010 p 355-361. Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB. Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation. J Am Coll Cardiol. 1997;30(3):784-90.

Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man

Background Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation. Case presentation We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination. Conclusion Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.

Intracardiac Masses I-Mass Study Single Center Experience Within 12 Years

Objective : The aim of this cross-sectional, retrospective, descriptive study was to review and classify cardiac masses systematically and to determine their frequencies.Methods : The medical records of 64,862 consecutive patients were investigated within 12 years. Every patient with a cardiac mass imaged by transthoracic echocardiography (TTE) and confirmed with an advanced imaging modality such as transesophageal echocardiography (TEE), computed tomography (CT) and / or cardiac magnetic resonance imaging (CMR) was included. Acute coronary syndromes triggering thrombus formation, vegetations, intracardiac device and catheter related thrombi were excluded.Results : Data demonstrated 127 (0.195 %) intracardiac masses consisting of 33 (0.050 %) primary benign, 3 (0.004 %) primary malignant, 20 (0.030 %) secondary tumors, 3 (0.004 %) hydatid cysts and 68 (0.104 %) thrombi respectively. The majority of primary cardiac tumors were benign (91.67 %), predominantly myxomas (78.79 %), and the less malignant (8.33 %). Secondary cardiac tumors were common than the primary malignant tumors (20:3), with male dominancy (55 %), lymphoma and lung cancers were the most frequent. Intracardiac thrombi was the majority of the cardiac masses, thrombi accompanying malignancies were in the first range (n=17, 25%), followed by autoimmune diseases (n=13, 19.12 %) and ischemic heart disease with low ejection fraction (n=12, 17.65 %).Conclusion: This retrospective analysis identified 127 patients with cardiac masses. The majority of benign tumors were myxoma, the most common tumors that metastasized to the heart were lymphoma and lung cancers, and the thrombi associated with malignancies and autoimmune diseases were the most frequent.

Successful Treatment of Recurrent Hyperpyrexia, Stroke, Intracardiac Thrombosis and Inflammatory Pseudotumor Secondary to Behçet’s Syndrome With Drug Therapy Alone

BackgroundBehçet’s syndrome (BS) is an inflammatory vessel disease characterized by recurrent oral and genital ulcers. It is a rare disorder that affects blood vessels throughout the body. It can affect any bodily system, including the skin, joints and cardiovascular, respiratory, central nervous and degestive systems. But cerebral infarction related to cerebral artery, intracardiac thrombosis (ICT) and inflammatory pseudotumor (IPT) are complications hard to see. And there is no effective therapy in clinic.Case presentationWe report the case of a 17-year-old patient with a two-month history of recurrent hyperpyrexia without obvious infection symptoms. He had a medical history of cerebral infarction ten months ago. Antinuclear antibody (ANA), antiphospholipid antibodies, parasite antibodies and antineutrophil cytoplasmic antibodies (ANCA) were all negative, consequently. Echocardiography demonstrates heterogeneous echoes in the right ventricle and apex. He was suspected to have cardiac myxomas and infective endocarditis and underwent thoracotomy afterwards. Histological examinations showed the specimen is inflammatory mass of vascular origin and intracardiac thrombus (ICT). However, the hyperpyrexia and intracardiac masses relapsed in two months. The antibiotic treatment failed to control the temperature and he was diagnosed as BS and treated with prednisone, aspirin and oral cyclophosphamide. Since then, the body temperature turned to normal and the size of intracardiac mass maintained stable. ConclusionBS should be considered as a causative factor in young man with stroke, intracardiac masses and hyperpyrexia. Glucocorticoid and immunosuppressive agents may be effective for IPT and ICT in patient with BS.

A rare cause of left ventricular outflow tract mass in infancy: Cardiac papillary fibroelastoma

Primary cardiac tumors are one of the rare causes of intracardiac masses in pediatric population. Cardiac papillary fibroelastomas are benign cardiac tumors with predilection for valvular endocardium, and the presentation is dictated by the cardiac structure involved and the tumor characteristics. We report an infant with cardiac papillary fibroelastoma manifesting as an asymptomatic left ventricular outflow tract mass. This case is being presented to emphasize the rare occurrence of cardiac papillary fibroelastoma in pediatric population and to be cognizant of this entity when considering differential diagnosis of intracardiac masses in this subgroup.

Cystic left ventricular mass: the utility of transthoracic echocardiography and cardiac MRI

Accurate identification of left ventricular masses (LVM) can be challenging, and if incorrect, may have devastating consequences. While transthoracic echocardiography is often the first test to identify intracardiac masses, cardiac MRI (CMRI) allows for better anatomical definition and tissue characterisation. We present a case of a 51-year-old man who presented with 4 weeks of shortness of breath, found on echocardiogram to have severely reduced LV function and a 2.5×4.0 cm LVM with a hypolucent/cystic core. Due to the unusual appearance, CMRI was required for confirmation of an LV thrombus. This case highlights the importance of multimodality imaging in the discovery and identification of LVM.

Multiple Intracardiac Masses as the Primary Presentation of a Systemic Inflammatory Disease: A Big Challenge (Case Report)

Antiphospholipid syndrome (APS) classically presents with venous or arterial thrombosis and pregnancy morbidity. Although clinical manifestations with fever of unknown origin and intracardiac masses are unusual, in a patient with prolonged fever and multiple intracardiac thrombi, systemic inflammatory diseases such as APS should be considered.