Asunto(s)
Anomalías Múltiples , Defecto del Tabique Aortopulmonar , Circulación Colateral/fisiología , Circulación Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Neoplasias Cardíacas/irrigación sanguínea , Anciano , Procedimientos Quirúrgicos Cardíacos/métodos , Angiografía Coronaria , Anomalías de los Vasos Coronarios/fisiopatología , Anomalías de los Vasos Coronarios/cirugía , Femenino , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/fisiopatología , HumanosRESUMEN
BACKGROUND: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is widely used to identify cardiac neoplasms, for which diagnosis is predicated on enhancement stemming from lesion vascularity: Impact of contrast-enhancement pattern on clinical outcomes is unknown. The objective of this study was to determine whether cardiac metastasis (CMET) enhancement pattern on LGE-CMR impacts prognosis, with focus on heterogeneous lesion enhancement as a marker of tumor avascularity. METHODS: Advanced (stage IV) systemic cancer patients with and without CMET matched (1:1) by cancer etiology underwent a standardized CMR protocol. CMET was identified via established LGE-CMR criteria based on lesion enhancement; enhancement pattern was further classified as heterogeneous (enhancing and non-enhancing components) or diffuse and assessed via quantitative (contrast-to-noise ratio (CNR); signal-to-noise ratio (SNR)) analyses. Embolic events and mortality were tested in relation to lesion location and contrast-enhancement pattern. RESULTS: 224 patients were studied, including 112 patients with CMET and unaffected (CMET -) controls matched for systemic cancer etiology/stage. CMET enhancement pattern varied (53% heterogeneous, 47% diffuse). Quantitative analyses were consistent with lesion classification; CNR was higher and SNR lower in heterogeneously enhancing CMET (p < 0.001)-paralleled by larger size based on linear dimensions (p < 0.05). Contrast-enhancement pattern did not vary based on lesion location (p = NS). Embolic events were similar between patients with diffuse and heterogeneous lesions (p = NS) but varied by location: Patients with right-sided lesions had threefold more pulmonary emboli (20% vs. 6%, p = 0.02); those with left-sided lesions had lower rates equivalent to controls (4% vs. 5%, p = 1.00). Mortality was higher among patients with CMET (hazard ratio [HR] = 1.64 [CI 1.17-2.29], p = 0.004) compared to controls, but varied by contrast-enhancement pattern: Diffusely enhancing CMET had equivalent mortality to controls (p = 0.21) whereas prognosis was worse with heterogeneous CMET (p = 0.005) and more strongly predicted by heterogeneous enhancement (HR = 1.97 [CI 1.23-3.15], p = 0.005) than lesion size (HR = 1.11 per 10 cm [CI 0.53-2.33], p = 0.79). CONCLUSIONS: Contrast-enhancement pattern and location of CMET on CMR impacts prognosis. Embolic events vary by CMET location, with likelihood of PE greatest with right-sided lesions. Heterogeneous enhancement-a marker of tumor avascularity on LGE-CMR-is a novel marker of increased mortality risk.
Asunto(s)
Medios de Contraste , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Imagen por Resonancia Cinemagnética , Meglumina , Células Neoplásicas Circulantes/patología , Compuestos Organometálicos , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Neoplasias Cardíacas/mortalidad , Neoplasias Cardíacas/secundario , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Ciudad de Nueva York , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Factores de RiesgoRESUMEN
We report a case of a 25-year-old man present with acute ST-segment elevation myocardial infarction caused by a large left atrial myxoma. Nutrient vessels of the atrial mass showed a unique ''dye brushes'' sign on coronary angiography.
Asunto(s)
Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Mixoma/irrigación sanguínea , Mixoma/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Adulto , Atrios Cardíacos/diagnóstico por imagen , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/cirugía , Humanos , Masculino , Mixoma/complicaciones , Mixoma/cirugía , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/etiologíaRESUMEN
Preoperative coronary angiography for cardiac myxoma not only excludes coronary artery disease but also detects the artery feeding the cardiac myxoma, which has several clinical implications. In this study, we examined cardiac myxoma cases in two tertiary hospitals using coronary angiography to identify the artery feeding the myxoma. We retrospectively reviewed 42 patients with cardiac myxoma who had undergone surgical removal between July 2008 and December 2015 in two tertiary hospitals, and recorded their baseline characteristics, echocardiographic findings, and coronary angiography. Among those 42 patients, 23 (55%) had coronary angiography before surgery and in no case was significant luminal narrowing observed. In 21 of the coronary angiograms, the artery feeding the cardiac myxoma had a vascular branch (100%), clusters of tortuous vessels with contrast medium pooling (67%), an arteriocavity fistula (33%), and a mobile feeding artery (67%). No significant relationship was found between coronary artery dominance type and the origin of the artery feeding the cardiac myxoma (P = 0.362). Identification of the artery feeding the cardiac myxoma, with a distinctive vascular appearance in coronary angiography, is important for several clinical applications such as helping to diagnose cardiac myxoma and to plan the surgical approach. Clin. Anat. 33:833-838, 2020. © 2019 Wiley Periodicals, Inc.
Asunto(s)
Angiografía Coronaria , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Mixoma/irrigación sanguínea , Mixoma/diagnóstico por imagen , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Myxoma is a common benign tumour found in the heart. On reviewing literature, we found some left atrial myxomas receive blood supply from the right coronary artery. Performing a coronary angiogram in a cardiac tumour has the following uses: (1) it shows the vascularity that can be ligated by the surgeon at operation; (2) if there is a blood supply visible, it may not be an intracardiac thrombus; (3) the coronary angiogram may detect a myxoma even before an echocardiogram does so; (4) some myxomas may bleed into the right atrium or left atrium and this may be seen on coronary angiography. We show here the neovascularity of a left atrial myxoma and its blood supply from the right coronary artery. We recommend that all routine coronary angiograms be reviewed carefully for any signs of tumour vascularity or tumour blush as this would prevent missing early myxomas. Echocardiography is the gold standard for detection of myxomas but literature has a number of intracardiac tumours that were detected only by the tumour blush. Some left atrial tumours have been treated by occluding their blood supply.The absence of a blood supply on coronary angiography could rule out a benign cardiac tumour that usually has a blood supply.
Asunto(s)
Angiografía Coronaria/métodos , Atrios Cardíacos/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Mixoma/diagnóstico por imagen , Adulto , Medicina Basada en la Evidencia , Femenino , Neoplasias Cardíacas/irrigación sanguínea , Humanos , Mixoma/irrigación sanguínea , Sensibilidad y EspecificidadRESUMEN
A 73-year-old woman presented with exertional chest pain and mild dyspnea for several months. In this case, preoperative coronary angiography showed neovascularization originating from the right coronary artery (RCA) and left circumflex (LCX). Vascular supply in left atrial myxomas usually originates from the LCX and sometimes from the RCA, but vascular supply from both the right and left coronary arteries is rarely seen.
Asunto(s)
Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Anciano , Procedimientos Quirúrgicos Cardíacos , Diagnóstico Diferencial , Ecocardiografía Transesofágica , Femenino , Atrios Cardíacos , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/cirugía , Humanos , Mixoma/irrigación sanguínea , Mixoma/cirugía , Enfermedades RarasRESUMEN
A 24-year-old woman was admitted to the hospital for abdominal pain. Abdominal contrast-enhanced computed tomography( CT)revealed a cystic mass measuring 11×8 cm in the left lobe of the liver with extravasation. Vascular embolization was performed, but extravasation remained on CT images. She was then transferred to our hospital. We performed an emergency extended left hepatectomy. Histopathological examination revealed solid proliferation of spindle-shaped cells. Immunohistochemical staining showed that the tumor cells were positive for vimentin and negative for AE1/AE3. Thus, a diagnosis of undifferentiated sarcoma was confirmed. Multiple recurrent tumors were recognized on CT images of the lung and right atrium taken 1 year and 10 months post-surgery. Partial resection of the tumor was performed for the right atrial mass, the left lingular segment, the left inferior lobe, and the right middle lobe. Pathological diagnosis confirmed metastasis of undifferentiated sarcoma from the liver. Chemotherapy consisting of vincristine, actinomycin D, and cyclophosphamide(VAC) was not effective, and the patient died 31 months after the primary surgery. Undifferentiated sarcoma of the liver is a rare malignant mesenchymal tumor, whose occurrence is extremely rare in adults. Although surgical treatment is the first choice, outcomes remain poor. Multimodality treatment should be used to improve the outcome.
Asunto(s)
Arterias/patología , Neoplasias Cardíacas/secundario , Neoplasias Hepáticas/patología , Sarcoma/secundario , Arterias/cirugía , Resultado Fatal , Femenino , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/cirugía , Hepatectomía , Humanos , Neoplasias Hepáticas/cirugía , Sarcoma/irrigación sanguínea , Sarcoma/cirugía , Adulto JovenAsunto(s)
Fístula/diagnóstico , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Fístula/etiología , Atrios Cardíacos , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/complicaciones , Humanos , Imagen por Resonancia Cinemagnética/métodos , Mixoma/irrigación sanguínea , Mixoma/inducido químicamente , Neovascularización PatológicaRESUMEN
BACKGROUND: Two-dimensional echocardiography is the main noninvasive imaging tool to identify cardiac masses but is unable to provide detailed tissue characterization. AIM: The aim of the study was to assess the ability of low mechanical index (MI) contrast echocardiography to detect presence and amount of tissue vascularization as validated by histopathology study of cardiac masses. METHODS AND RESULTS: Twelve consecutive patients (5 females and 7 males, age range 51-82 years) underwent conventional and contrast two-dimensional echocardiography with low MI. By contrast echocardiography, mass enhancement was classified as absent (suggesting thrombus), partial, or complete (suggesting vascularized mass, both with early or late >20 cycles of opacification) as compared to the adjacent myocardium. The precise nature of the cardiac masses was provided by histopathology examination and/or by resolution after anticoagulation therapy during follow-up. Presence, type, and degree of mass vascularization were assessed by histology, immunohistochemistry, and morphometric analysis. Among the 12 cases, mass enhancement was absent, late and peripheral, late and partial, and early and complete in three cases each. Cardiac masses consisted of thrombus (three), secondary malignant cardiac tumor (three), myxoma (three), papillary fibroelastoma (two), and cavernous hemangioma (one). At histology, cardiac hemangioma had the highest degree of vascularization, at difference from thrombi which were not vascularized, and data were in keeping with contrast echocardiography findings. CONCLUSIONS: Low MI contrast echocardiography is an easy, noninvasive cardiac imaging tool to assess cardiac mass vascularization. The degree of contrast enhancement and time to opacification are highly variable among cardiac masses and correspond to different extent of vascularization.
Asunto(s)
Ecocardiografía/métodos , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patología , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Medios de Contraste , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/patología , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Neoplasias Cardíacas/irrigación sanguínea , Humanos , Masculino , Persona de Mediana Edad , Mixoma/diagnóstico por imagen , Mixoma/patología , Metástasis de la Neoplasia/diagnóstico por imagen , Metástasis de la Neoplasia/patologíaRESUMEN
Right atrial tumor thrombus is rare in patients with visceral malignant tumors and can cause right heart failure or sudden death. We present 2 cases of right atrial tumor thrombus treated under deep hypothermic intermittent circulatory arrest (DHICA). A 45-year-old man with right heart failure was diagnosed with right renal cancer extending to the right atrium. Computed tomography revealed no metastasis. He underwent right nephrectomy and tumor thrombus resection under DHICA. He was discharged on postoperative day 11 in good clinical course. A 67-year-old woman with hepatitis C virus liver cirrhosis( Child-Pugh A) was diagnosed with hepatocellular carcinoma and right atrial tumor. She underwent S8 and tumor thrombus resection under DHICA. Hemorrhagic diathesis was controlled using fresh frozen plasma transfusion. She was discharged on postoperative day 24 without liver failure. In cases of atrial tumor thrombus resection, DIHCA may be useful to achieve a bloodless operation field because the procedure is relatively simple and the primary disease need not be considered.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Carcinoma de Células Renales/cirugía , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/cirugía , Neoplasias Renales/cirugía , Neoplasias Hepáticas/cirugía , Trombosis/cirugía , Anciano , Carcinoma Hepatocelular/irrigación sanguínea , Carcinoma Hepatocelular/secundario , Carcinoma de Células Renales/irrigación sanguínea , Carcinoma de Células Renales/secundario , Paro Circulatorio Inducido por Hipotermia Profunda , Resultado Fatal , Femenino , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/secundario , Humanos , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/patología , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , RecurrenciaAsunto(s)
Neoplasias Cardíacas/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Paraganglioma/diagnóstico por imagen , Adulto , Angiografía Coronaria , Ecocardiografía , Femenino , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/patología , Ventrículos Cardíacos/patología , Humanos , Paraganglioma/irrigación sanguínea , Paraganglioma/patologíaRESUMEN
Cardiac paraganglioma is a rare entity. We review the clinical data from 158 patients reported in 132 isolated papers, and discuss clinical presentations, imaging findings, pathology, location, therapy, and outcomes.
Asunto(s)
Neoplasias Cardíacas , Paraganglioma , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Vasos Coronarios , Diagnóstico por Imagen , Femenino , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/terapia , Humanos , Masculino , Persona de Mediana Edad , Pericardio , PubMed , Adulto JovenAsunto(s)
Taponamiento Cardíaco/etiología , Coriocarcinoma/irrigación sanguínea , Coriocarcinoma/secundario , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/secundario , Hemorragia/complicaciones , Neoplasias Testiculares/complicaciones , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundario , Taponamiento Cardíaco/diagnóstico , Coriocarcinoma/diagnóstico , Quimioterapia , Resultado Fatal , Neoplasias Cardíacas/diagnóstico , Hemorragia/diagnóstico , Humanos , Neoplasias Renales/diagnóstico , Neoplasias Renales/secundario , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/secundario , Neoplasias Testiculares/patologíaRESUMEN
Although angiographically detectable neovascularity is being reported with increasing frequency in patients with cardiac myxoma, associated coronary fistula to the cardiac chamber has not been described. We report a 62-year-old woman in whom cardiac computed tomography (CT) enabled the noninvasive diagnosis of a left atrial myxoma with neovascularization arising from the left circumflex artery and the formation of an unusual fistula into the left atrial cavity, with concomitant evaluation of the coronary arteries. Careful suture ligation of a supplying coronary branch in the atrial septum was performed during tumor excision to prevent the development of intra-atrial steal.
Asunto(s)
Fístula/complicaciones , Atrios Cardíacos , Cardiopatías/complicaciones , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico por imagen , Tomografía Computarizada Multidetector , Mixoma/irrigación sanguínea , Mixoma/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Femenino , Neoplasias Cardíacas/complicaciones , Humanos , Persona de Mediana Edad , Mixoma/complicaciones , Neovascularización Patológica , UltrasonografíaAsunto(s)
Embolización Terapéutica/métodos , Neovascularización Patológica/terapia , Adulto , Dopamina , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/terapia , Humanos , Masculino , Paraganglioma/irrigación sanguínea , Paraganglioma/diagnóstico , Paraganglioma/patología , Paraganglioma/terapiaAsunto(s)
Ablación por Catéter , Neoplasias Cardíacas/cirugía , Paraganglioma/cirugía , Venas Pulmonares/cirugía , Fibrilación Atrial/etiología , Angiografía Coronaria , Ecocardiografía , Femenino , Atrios Cardíacos/patología , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/diagnóstico , Humanos , Persona de Mediana Edad , Paraganglioma/irrigación sanguínea , Paraganglioma/diagnóstico , Venas Pulmonares/patología , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Tabiques Cardíacos/cirugía , Paraganglioma/diagnóstico , Paraganglioma/cirugía , Biomarcadores de Tumor/análisis , Angiografía Coronaria , Vasos Coronarios , Ecocardiografía , Femenino , Atrios Cardíacos/patología , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/irrigación sanguínea , Neoplasias Cardíacas/patología , Tabiques Cardíacos/patología , Humanos , Interpretación de Imagen Asistida por Computador , Imagenología Tridimensional , Persona de Mediana Edad , Paraganglioma/irrigación sanguínea , Paraganglioma/patología , Tomografía Computarizada por Rayos XAsunto(s)
Circulación Coronaria , Vasos Coronarios/fisiopatología , Neoplasias Cardíacas/irrigación sanguínea , Hemodinámica , Mixoma/irrigación sanguínea , Procedimientos Quirúrgicos Cardíacos , Vasos Coronarios/diagnóstico por imagen , Ecocardiografía , Femenino , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/etiología , Enfermedades de las Válvulas Cardíacas/fisiopatología , Humanos , Persona de Mediana Edad , Mixoma/complicaciones , Mixoma/diagnóstico , Mixoma/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The purpose of this study was to provide proof of concept for a new three-dimensional (3D) radial dynamic contrast enhanced MRI acquisition technique, called "Radial Entire Tumor with Individual Arterial input function dynamic contrast-enhanced MRI" (RETIA dynamic contrast-enhanced MRI), which allows for the simultaneous measurement of an arterial input function in the mouse heart at 2 s temporal resolution and coverage of the whole tumor. Alternating 2D and 3D projections contribute to the 2D heart image or 3D tumor data with a 3-cm field of view. Sixty-four 2D images of the heart are obtained during acquisition of each 3D tumor dataset. In a pilot study, global K(trans) and ve values were measured in four mice, in a respiratory motion-animated subcutaneously implanted breast tumor model. This technique is expected to be most useful for the characterization of microvasculature in motion-animated orthotopic tumors.