Hallazgos de la PET-TC con 18F-FDG en un angiosarcoma cardíaco complicado con una rotura cardíaca / Findings of the 18F-FDG PET-CT in a cardiac angiosarcoma complicated by a cardiac rupture

Los tumores malignos primarios del corazón son una patología muy poco frecuente y de ellos, el tipo más frecuente es el angiosarcoma cardíaco. Esta patología tiene una clínica muy inespecífica y puede ser muy difícil de diagnosticar por técnicas convencionales de imagen. Presentamos el caso de un paciente con un angiosarcoma cardíaco que además presentaba una complicación muy poco frecuente, una rotura cardíaca, lo que hizo necesario el uso de la 18F-FDG PET-TC para demostrar la malignidad de la masa y poder llegar a un diagnóstico definitivo (AU)

Primary malignant tumors of the heart are a rare condition. The most common type is the cardiac angiosarcoma. he symptoms of this disease are very nonspecific and can be very difficult to diagnose by conventional imaging techniques. We report the case of a male patient with cardiac angiosarcoma who also had a rare complication, this being cardiac rupture, which required the use of 18F-FDG PET-CT to demonstrate the mass malignancy and to reach a definitive diagnosis (AU)

Coronary microvascular spasm triggers transient ischemic left ventricular diastolic abnormalities in patients with chest pain and angiographically normal coronary arteries.

AIMS: Impaired coronary microvascular dilatory function can lead to exercise induced myocardial ischemia and angina pectoris even in patients without significant (>50%) obstructive coronary atherosclerosis (APWOCA). Diffuse distal vessel epicardial spasm and microvascular spasm have been also proposed as a plausible explanation for angina at rest in these patients. However, objective systematic evidence for the latter i.e. echocardiographic wall motion abnormalities during angina, is lacking at present. Coronary epicardial and microvascular spasm can be triggered in susceptible patients by the administration of intracoronary acetylcholine (Ach). We sought to assess whether Ach induced diffuse distal epicardial coronary artery spasm (≥75% diameter reduction) and coronary microvascular spasm can cause transient ischemic left ventricular dysfunction, as assessed by echocardiography. METHODS: 50 patients (19 men aged 60.5 ± 8.9 years) with stable APWOCA were assessed for coronary spasm and myocardial ischemia with intracoronary Ach infusion, 2D transthoracic echocardiography (before and during Ach testing), continuous 12-lead ECG monitoring, and ultrasensitive cardiac troponin (US-cTn) measurement before and within 4 h after Ach testing. RESULTS: 14 patients (28%) had a "negative" Ach test, 14 (28%) developed coronary microvascular spasm and 17 (34%) had diffuse distal epicardial spasm. In 5 patients (10%) the test was inconclusive. Echocardiographic variables including deceleration time, EF slope and E/A, as well as ultrasensitive-cTn concentrations were abnormal during Ach induced ischemic ECG changes. CONCLUSIONS: We have, for the first time, demonstrated that Ach induced coronary microvascular spasm is associated with echocardiographic changes and ultrasensitive-cTn elevations, indicative of myocardial ischemia.

[Findings of the (18)F-FDG PET-CT in a cardiac angiosarcoma complicated by a cardiac rupture]. / Hallazgos de la PET-TC con (18)F-FDG en un angiosarcoma cardíaco complicado con una rotura cardíaca.

Primary malignant tumors of the heart are a rare condition. The most common type is the cardiac angiosarcoma. The symptoms of this disease are very nonspecific and can be very difficult to diagnose by conventional imaging techniques. We report the case of a male patient with cardiac angiosarcoma who also had a rare complication, this being cardiac rupture, which required the use of (18)F-FDG PET-CT to demonstrate the mass malignancy and to reach a definitive diagnosis.