RESUMEN
Acute limb ischaemia (ALI) secondary to cardiac myxoma is uncommon. Embolic myxoma should be considered a differential diagnosis in young patients with ALI who do not have apparent cardiovascular risk factors. A multidisciplinary approach and comprehensive care can improve outcomes and optimise the collaborative treatment of ALI. Early referral to a hospital that can provide specialised treatment for ALI helps prevent significant tissue loss and surgical complications, such as amputation.A man in his 20s presented with bilateral ALI of both lower extremities, and an arterial duplex scan revealed a thrombus occluding all arterial segments of the bilateral lower extremities. An intracardiac mass adherent to the apical and anterior interventricular septum on two-dimensional echocardiography suggested a complex myxoma. The patient was diagnosed with ALI Rutherford category III, and bilateral hip disarticulation was performed. The patient was discharged with an anticoagulant.
Asunto(s)
Embolia , Neoplasias Cardíacas , Mixoma , Enfermedades Vasculares Periféricas , Masculino , Humanos , Enfermedades Vasculares Periféricas/complicaciones , Embolia/complicaciones , Ventrículos Cardíacos/diagnóstico por imagen , Isquemia/cirugía , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Mixoma/diagnóstico , Mixoma/diagnóstico por imagenRESUMEN
BACKGROUND: Focal 68Ga-DOTATATE PET lesions within the myocardium of neuroendocrine tumor (NET) patients are observed in clinical practice. We determined the frequency and characteristics of lesions that are consistent with cardiac metastasis and assessed the lesion detection rate of conventional imaging. METHODS: 629 patients who underwent 68Ga-DOTATATE PET-CT at a supraregional comprehensive cancer center on NET were included from a consecutive registry. Inclusion criteria were: (1) focal 68Ga-DOTATATE tracer uptake within the myocardium in more than two sequential PET exams, and (2) contrast-enhanced CT. To determine the diagnostic accuracy of conventional CT imaging, a case-control cohort with a ratio of 1:3 was used. PET and CT were independently analyzed by two blinded readers. Cohen's κ was assessed for interreader agreement. Descriptive statistics were applied for frequencies and characteristics and group comparisons were analyzed using the Fisher's exact test. RESULTS: The prevalence of myocardial metastases related to the registry was 2.4% (15 of 629 NET patients fulfilling the inclusion criteria), for a total of 21 myocardial 68Ga-DOTATATE foci detected. Myocardial lesions were most frequently located in the left ventricle (43%) and the septum (43%). No patient demonstrated a pericardial effusion. Patients with myocardial metastases did not differ in demographics, tumor grading, disease stage or circulating tumor markers compared to the overall registry (all p > 0.05). Higher Ki67-Indices were observed (p = 0.049) for patients with myocardial metastases. Interreader agreement for PET assessment was excellent (Cohen's κ = 1.0). CT reading showed a sensitivity of 19% (95% confidence interval: 6-43%) at a specificity of 100% (95% confidence interval: 90-100%). CONCLUSIONS: 68Ga-DOTATATE PET enables detection of myocardial metastatic lesions in NET patients. In contrast, standard morphologic CT imaging provides very limited sensitivity.
Asunto(s)
Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/secundario , Tumores Neuroendocrinos/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Compuestos OrganometálicosAsunto(s)
Bloqueo Atrioventricular/etiología , Nodo Atrioventricular , Muerte Súbita Cardíaca/etiología , Neoplasias Cardíacas/complicaciones , Neoplasias Quísticas, Mucinosas y Serosas/complicaciones , Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/terapia , Nodo Atrioventricular/diagnóstico por imagen , Nodo Atrioventricular/cirugía , Estimulación Cardíaca Artificial , Muerte Súbita Cardíaca/prevención & control , Técnicas Electrofisiológicas Cardíacas , Femenino , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias Quísticas, Mucinosas y Serosas/diagnóstico por imagen , Neoplasias Quísticas, Mucinosas y Serosas/cirugía , Marcapaso Artificial , Factores de Riesgo , Resultado del TratamientoRESUMEN
Papillary fibroelastoma is a rare, benign tumor, and multiple papillary fibroelastomas are even more uncommon. In an asymptomatic patient scheduled for carotid endarterectomy, transthoracic echocardiography discovered a fibroelastoma on the mitral valve. Then, transesophageal echocardiography showed another fibroelastoma on the aortic valve. Because he also needed a right coronary artery bypass, the patient underwent surgical excision of both masses. Fibroelastomas are not always as innocent as they seem, and surgical excision is necessary because of their potential for systemic or coronary embolization. Transoesophageal echocardiography may improve the diagnosis of multiple papillary fibroelastomas.
Asunto(s)
Ecocardiografía Transesofágica/métodos , Fibroma/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Anciano , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Diagnóstico Diferencial , Fibroma/cirugía , Estudios de Seguimiento , Neoplasias Cardíacas/cirugía , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Resultado del TratamientoAsunto(s)
Técnicas Electrofisiológicas Cardíacas , Neoplasias Cardíacas/cirugía , Lipoma/cirugía , Taquicardia Ventricular/cirugía , Adulto , Bloqueo de Rama/complicaciones , Electrocardiografía , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Humanos , Imagenología Tridimensional , Periodo Intraoperatorio , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Masculino , Radiografía , Taquicardia Ventricular/etiologíaRESUMEN
We describe a case of a young patient admitted for recurrent ischemic stroke caused by a papillary fibroelastoma of the mitral valve and a hyperhomocysteinemia. A papillary fibroelastoma is a benign cardiac tumor which can be associated with serious embolic complications. A moderate plasma level of hyperhomocysteinemia is considered as a risk factor of ischemic stroke. The authors suggest that this association increases the risk of ischemic stroke in their patient. The tumor was surgically removed to avoid new embolic events associated with a vitamin B supplementation. After surgery and acid folic supplementation, no recurrence was observed.