RESUMO
Congenital left atrial appendage aneurysm is an extremely rare anomaly. It is seen at any time ranging from fetal to ninth decade of life. Patients with left atrial appendage aneurysm may be asymptomatic, or present with dyspnea, arrhythmias, thromboembolic phenomenon. We report a case of prenatal diagnosis at 26 weeks of gestation, postnatal management and outcome of left atrial appendage aneurysm.
Assuntos
Apêndice Atrial , Aneurisma Cardíaco , Cardiopatias Congênitas , Apêndice Atrial/diagnóstico por imagem , Dispneia , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Humanos , Gravidez , Diagnóstico Pré-NatalRESUMO
A 75-year-old woman underwent preoperative echocardiography, which revealed a mass in the left atrium; however, cardiac magnetic resonance imaging showed no mass. Echocardiography revealed an enlargement of the epicardial adipose tissue in the left atrioventricular groove, therefore a pseudomass. Causes of cardiac pseudomass on echocardiography have been reported. Suspected pseudomasses should be reliably differentiated from a tumor or thrombus, and if new forms are found, the images must be shared for the benefit of clinicians.
Assuntos
Tecido Adiposo , Ecocardiografia , Tecido Adiposo/diagnóstico por imagem , Idoso , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Pericárdio/diagnóstico por imagemRESUMO
The differential diagnosis of a left atrial mass on echocardiogram includes thrombus, vegetation, tumour, and other rare causes like septal aneurysm, pulmonary vein remnant, and septal haematoma. We present interesting echocardiographic images of a rare condition which can masquerade as a left atrial mass following cardiac surgery.
Assuntos
Apêndice Atrial , Procedimentos Cirúrgicos Cardíacos , Veias Pulmonares , Trombose , Apêndice Atrial/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Diagnóstico Diferencial , Ecocardiografia , Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , HumanosRESUMO
Intracardiac blood cysts are rare congenital malformations most commonly located in the endocardium of semilunar or atrioventricular valves. They are predominantly seen in infants, especially below 2 months of age, and disappear spontaneously in the first 6 months of life making the detection of blood cysts a rare finding in the adult population. Although most patients are asymptomatic, they may occasionally present with obstruction, valvular dysfunction, or embolism. Herein, we present a 2.5-year-old female patient, who was successfully treated with surgical excision of an intracardiac blood cyst causing mild-to-moderate mitral regurgitation and obstruction.
Assuntos
Cistos , Embolia , Insuficiência da Valva Mitral , Adulto , Criança , Pré-Escolar , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgiaRESUMO
Our case was initially admitted with chest discomfort and congestive heart failure with a presumptive diagnosis of non-ST segment elevation myocardial infarction and was later found to have a large left atrial (LA) mass. In addition to a complete echocardiography study, multimodality imaging was utilized to better characterize the LA mass. Despite this, the diagnosis could not be confirmed. It was decided to proceed to cardiac surgery, and surprisingly, this revealed a large LA mass with pockets of fresh blood within the LA. Pathological specimen examination confirmed a diagnosis of thrombus, effectively outruling other atrial neoplasms. Although contrast echocardiography and cardiac magnetic resonance imaging suggested this diagnosis, in the absence of any predisposing factors, the final diagnosis was made at surgery and histopathological examination.
Assuntos
Apêndice Atrial , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Hematoma/diagnóstico por imagem , HumanosRESUMO
Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare benign finding made of mesothelial cells, histiocytes, and fibrin, usually found during heart valve surgery. The clinical relevance resides in the potential misdiagnosis as metastatic carcinoma or arterial embolism. The pathogenesis remains uncertain, with artifactual and reactive hypotheses. Here we present a case of MICE with paradigmatic clinical, imaging, and histological features in a 28-year-old woman with undifferentiated connective tissue disease without previous cardiac catheterization with possible pathogenesis, highlighting the importance of awareness of the existence of this lesion in patients with autoimmune disease.
Assuntos
Doenças Autoimunes/complicações , Cardiomiopatias/patologia , Cardiomiopatias/cirurgia , Doenças do Tecido Conjuntivo/complicações , Epitélio/patologia , Achados Incidentais , Monócitos/patologia , Miocárdio/patologia , Adulto , Procedimentos Cirúrgicos Cardíacos , Cardiomiopatias/etiologia , Diagnóstico Diferencial , Feminino , HumanosRESUMO
A 74-year-old female current 75 pack-year smoker presented with shortness of breath and mild hemoptysis. Chest computed tomography showed a large right upper lobe mass compressing the superior vena cava, invading the right pulmonary veins, and occupying the majority of the left atrium. Brain magnetic resonance imaging revealed a 13 mm right parietal lesion with surrounding edema consistent with metastasis. A 3D TEE showed a large mobile mass in the left atrium. Bronchoscopy confirmed that the tumor mass was consistent with a moderately to poorly differentiated squamous cell carcinoma. She underwent chemotherapy, radiation, and immune therapy. She was also started on warfarin for anticoagulation after the initial chemotherapy with resolution of the left atrial mass. We feel that the patient most likely had carcinogenic thrombus in the pulmonary veins and left atrium.
Assuntos
Neoplasias Encefálicas/secundário , Carcinoma de Células Escamosas/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Idoso , Anticoagulantes/uso terapêutico , Encéfalo/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Broncoscopia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Feminino , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/terapia , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X/métodos , VarfarinaRESUMO
Left atrial (LA) masses are known to be associated with peripheral embolization. Accurate identification of etiology is crucial because treatment strategies may differ. We present the case of a young woman, who was initially diagnosed with a LA thrombus and anticoagulated. The diagnosis was revised to a primary cardiac tumor after review of the echocardiographic findings. Surgical excision revealed an atrial myxoma in an unusual location.
Assuntos
Apêndice Atrial/diagnóstico por imagem , Ecocardiografia Doppler/métodos , Ecocardiografia Transesofagiana/métodos , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Adulto , Feminino , Humanos , Tomografia Computadorizada por Raios XRESUMO
Cardiac metastasis of Ewing's sarcoma is exceedingly rare. A 40-year-old male was admitted with complaints of nonproductive cough, exertional dyspnea, and fatigue since 4 months with a history of abdominal wall swelling which was excised and proven to be Ewing's sarcoma/primitive neuroectodermal tumor (PNET). A transthoracic echocardiography demonstrated inhomogeneous mass located posterior to the left ventricle and a solitary mass protruding into the left atrium through the left inferior pulmonary vein. Due to accompanying pulmonary metastasis and possible poor outcome of the surgery, surgical resection was not considered.
Assuntos
Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana/métodos , Átrios do Coração , Neoplasias Cardíacas/secundário , Neoplasias Pulmonares/secundário , Sarcoma de Ewing/patologia , Adulto , Diagnóstico Diferencial , Neoplasias Cardíacas/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Veias Pulmonares , Doenças Raras , Tomografia Computadorizada por Raios XRESUMO
A 79 year-old-man presented three episodes of upper gastrointestinal bleeding and weight loss. Endoscopy revealed bleeding and extrinsic compression at the pyloric region. Computed tomography scan showed a pancreatic tumor, peritoneal carcinomatosis, vascular infiltration, and incidentally found a partially calcified hypodense lesion of 35 mm in the left atrium, suggesting a myxoma or a thrombus. Echocardiography revealed moderate left atrium enlargement, dilated left atrial appendage with spontaneous echo contrast, moderate dilatation and dysfunction of the left ventricle, ejection fraction was 39%, and an atrial septal aneurysm in which a piriform, mass of 35×33×25 mm, was "sitting," suggesting an organized thrombus.
Assuntos
Septo Interatrial , Ecocardiografia Transesofagiana/métodos , Hemorragia Gastrointestinal/complicações , Aneurisma Cardíaco/complicações , Cardiopatias/diagnóstico , Trombose/diagnóstico , Idoso , Diagnóstico Diferencial , Aneurisma Cardíaco/diagnóstico , Cardiopatias/etiologia , Humanos , Masculino , Trombose/etiologiaRESUMO
Invagination of an appendage into the left atrium is a rare complication. It occurs spontaneously or after open-heart surgery. In our case, a postoperative transesophageal echocardiogram, after closure of a ventricular septal defect in a 5-month-old infant, revealed a large mass in the left atrium. A diagnosis of a left appendage inversion was confirmed after external examination of the heart. Herein, we provide echocardiographic images before, during, and after manual reversion of the left appendage. Misdiagnosis of this complication could have led to an additional unnecessary surgical procedure that could have impacted on the patient's morbidity.
Assuntos
Apêndice Atrial/diagnóstico por imagem , Ponte Cardiopulmonar , Ecocardiografia Transesofagiana/métodos , Comunicação Interventricular/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Diagnóstico Diferencial , Átrios do Coração/diagnóstico por imagem , Humanos , LactenteRESUMO
Formation of an intramural left atrial hematoma (ILAH) is a rare complication of coronary artery stenting. Rapid diagnosis with noninvasive multimodality imaging can potentially be lifesaving. We report a case of ILAH that resulted in left ventricular inflow obstruction and pericardial tamponade in a 55-year-old male who presented with hemodynamic instability and worsening dyspnea three weeks after seemingly uncomplicated left circumflex artery stenting. We demonstrate features on transthoracic echocardiography with contrast and cardiac computed tomography that were used for diagnosis and management.
Assuntos
Angiografia Coronária/métodos , Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Stents/efeitos adversos , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/efeitos adversos , Reperfusão Miocárdica/instrumentação , Doenças Raras/diagnóstico por imagem , Doenças Raras/etiologiaRESUMO
BACKGROUND AND AIM: Increased left atrial (LA) mass was introduced as a compensatory mechanism in heart failure (HF) patients. Furthermore, atrial conduction time and LA emptying fraction is are deteriorated in HF with preserved ejection fraction (HFpEF). The aim of this study was to assess the early LA changes in HFpEF patients. METHODS: In 79 consecutive patients with HFpEF (age 61±8 years, NYHA class I-III, LV EF ≥45%), a complete 2-dimensional, M-mode, and Doppler echocardiographic study was performed. According to the diastolic dysfunction (DD), patients were divided into three groups: Group I-29 healthy subjects (control group); Group II-HFpEF patients with mild DD; and Group III-HFpEF patients with moderate DD. RESULTS: The LV mass was increased (P<.05), septal s', lateral s', septal and lateral MAPSE were decreased (P<.05, for all), E/e' ratio was increased (P<.001), LA mass and minimal volume were increased (P<.001, P<.05), LA emptying fraction was decreased (P<.05), and LA dyssynchrony was deteriorated (P<.05) in patients with mild DD compared to controls. These changes were of the same nature in patients with moderate LV DD. CONCLUSIONS: In early stage of DD, in patients with HFpEF, in addition to LV hypertrophy and compromised LV longitudinal systolic function, the LA emptying fraction is reduced, LA mass and LAV min are increased and LA dyssynchrony is significant, despite normal LA dimensions. These findings suggest early LA function deterioration irrespective of normal cavity measurements, hence a need for optimum therapy.
Assuntos
Função Atrial , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia , Remodelamento Atrial , Progressão da Doença , Diagnóstico Precoce , Ecocardiografia Doppler/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Hipertrofia Ventricular Esquerda/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/etiologiaRESUMO
Hiatal hernia (HH) is a common disease in the general population. It is often asymptomatic, but if it does present clinical manifestations, these are usually gastrointestinal. Gastroesophageal reflux is the main symptom that accompanies it. Depending on the severity of the hernia, it is classified into several subtypes from I-IV. Especially, IV type (giant HH) can lead to various cardiopulmonary symptoms with several degrees of severity. It is necessary to keep this possibility in mind among the various differential diagnoses that may occur in this clinical setting. The current paper aims to review the literature on classic and novel information on the HH - cardiovascular system relationship. Epidemiological data, physiological aspects of the heart compressed by HH, cardiovascular symptoms, electrocardiographic changes, echocardiographic alterations and clinical implications are discussed.
Normally, the stomach and the heart are not in direct contact because they are in different cavities, the thorax and the abdomen, respectively. When part of the stomach moves toward the chest through the diaphragm, we say there is a hiatal hernia (HH). Most of the time the HH symptoms are mild and clearly digestive. In severe cases, surgical repair of the HH is required. Even in these circumstances, digestive symptoms continue to be the most frequent. However, some patients present cardiovascular symptoms and few or no digestive symptoms. This easily creates diagnostic confusion, which leads to incorrect treatments and unnecessary expenses. In extreme cases, as seen in giant HH, the degree of cardiovascular involvement is very serious. There are documented cases that have suffered cardiac arrest, arrhythmias of different types and symptoms like classic acute myocardial infarction. It is required that clinical doctors and surgeons are aware that this complication exists. Only with this in mind can a timely diagnosis be achieved. Some emergency measures have been saving, gastric decompression with a tube being the most important. The main mechanism that explains the serious cardiovascular consequences of giant HH is cardiac compression. The dissemination of this knowledge can help save lives.
Assuntos
Refluxo Gastroesofágico , Hérnia Hiatal , Hérnia Hiatal/complicações , Humanos , Refluxo Gastroesofágico/fisiopatologia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/complicações , Eletrocardiografia/métodos , Ecocardiografia/métodos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Índice de Gravidade de DoençaRESUMO
Atrial myxomas are typically found in the left atrium and are the most common among overall rare cardiac tumors. Herein, we describe the clinical course of a 72-year-old female with non-small cell lung adenocarcinoma found to have an atrial mass during an imaging for evaluation for lung cancer progression. Differentiating between distinct types of masses can pose a challenge to the treatment team especially in the setting of exiting malignancy. This case demonstrates the complex decision making involved in the diagnosis, and timing of intervention to remove atrial mass in patients with frailty and a fast-growing cardiac mass.
RESUMO
Echocardiography is the investigational tool of choice for identifying cardiac masses. However, extracardiac masses may lead to a misdiagnosis. We present a unique case of a massive hiatus hernia in a 93 year-old woman, compressing on the left atrium, mimicking a left atrial mass. Echocardiographic features suggestive of a hiatus hernia are discussed.
Assuntos
Ecocardiografia , Cardiopatias/diagnóstico por imagem , Hérnia Hiatal/diagnóstico por imagem , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Átrios do Coração/diagnóstico por imagem , HumanosRESUMO
Cardiac myxoma recurrence is uncommon following surgical resection. Recurrence is about 2-3% in familial cases; however, recurrence is uncommon in sporadic cases. Most of the recurrences will occur during the first three to four years. Ten percent of myxomas are of the inherited autosomal dominant disorder called Carney's complex, while the rest appear sporadic. We are reporting a nonfamilial case of atrial myxoma, recurring rapidly seven years after resection of the initial left atrial myxoma with a pathologically proven clear margin and no malignant transformation. Cardiac neoplasms are rare and occur less commonly than metastatic disease of the heart. Congestive heart failure symptoms and thromboembolism account for nearly half of the presenting signs and symptoms. The initial presentation of our case was an embolic phenomenon, presenting with a stroke. The patient subsequently underwent resection of the mass, with pathology confirming the complete excision of the myxoma with a clear margin and no evidence of malignant transformation. Our patient was closely followed up in the clinic on annual transthoracic echocardiography surveillance, with a recurrence noted on surveillance echocardiography in 2021 (seven years after initial diagnosis) despite the patient being asymptomatic. This case illustrates transthoracic echocardiography as the mainstay of detection of recurrent left atrial myxoma; however, it also asks the question of how often patients need to be screened for recurrence of left atrial myxoma and for how long they need to have surveillance echocardiography. Clinical presentation and transesophageal echocardiographic views are extremely helpful in sharpening the accuracy of the diagnosis.
RESUMO
Left atrial masses are rare but clinically significant findings, which can present as diverse pathological entities, including primary tumors, thrombi, and metastases. Their diverse pathological entities contribute to a wide range of clinical manifestations, often presenting with nonspecific symptoms that pose challenges for early diagnosis. Within the realm of medicine, unique presentations emphasize the intricate interplay between the size, location, and functional impact of pathological processes. They serve as reminders to healthcare providers to approach each patient as an individual, recognizing that even seemingly minor abnormalities can have significant consequences. To illustrate this, we present two distinct cases of patients with left atrial masses, showcasing the importance of clinical suspicion and a wide knowledge base in identifying and managing these conditions effectively.
RESUMO
Uterine leiomyosarcoma (ULMS) is a rare malignancy arising from the myometrial smooth muscle wall, and cardiac metastases are extremely rare. Metastasis to the heart is a very unusual finding, and atrial metastasis is even rarer. Here, we report a case of a 45 year old woman who presented with dyspnea and pleural effusion and had a significant history of hysterectomy done for ULMS. Magnetic resonance imaging revealed a left atrial mass, which was resected and revealed to be a metastasis of leiomyosarcoma on histopathology and immunohistochemistry. Metastatic ULMS may rarely present as a left atrial mass with acute clinical presentation. Detailed clinical history and accurate diagnosis are vital for further management.
Assuntos
Fibrilação Atrial , Leiomiossarcoma , Neoplasias Uterinas , Feminino , Humanos , Pessoa de Meia-Idade , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia , Átrios do Coração/patologia , Pulmão/patologiaRESUMO
Transthoracic and transesophageal echocardiography detected a left atrial mass attached to the intra-atrialseptum. Intravenous contrast agent ruled out atrial thrombus, sugesting a left atrial myxoma. This highlights theimportance of contrast echocardiography for differential diagnosis of left atrial findings.