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2.
Medicine (Baltimore) ; 99(2): e18717, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914085

RESUMO

BACKGROUND: Cardiac masses are rare, but lead to high risk of stroke and death. Because of the different treatment methods, it is significant for clinicians to differentiate the nature of masses. Cardiac magnetic resonance (CMR) imaging has high intrinsic soft-tissue contrast and high spatial and temporal resolution and can provide evidence for differential diagnosis of cardiac masses. However, there is no evidence-based conclusion as to its accuracy. Therefore, the purpose of our study is to perform a systematic review on this issue and provide useful information for clinical diagnosis and treatment. METHODS: We will perform a systematic search in EMBASE, Cochrane Library, PubMed and Web of Science for diagnostic studies using CMR to detect cardiac masses from inception to October, 2019. Two authors will independently screen titles and abstracts for relevance, review full texts for inclusion and conduct detail data extraction. The methodological quality will be assessed using the QUADAS-2 tool. If pooling is possible, we will use bivariate model for diagnostic meta-analysis to estimate summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CMR, as well as different sequences of CMR. Estimates of sensitivity and specificity from each study will be plotted in summary receive operating curve space and forest plots will be constructed for visual examination of variation in test accuracy. If enough studies are available, we will conduct sensitivity analysis and subgroup analysis. RESULTS: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION: To our knowledge, this will be the first systematic review on the accuracy of CMR in the differential diagnosis of cardiac masses. This study will provide evidence and data to form a comprehensive understanding of the clinical value of CMR for cardiac masses patients. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required, as this study is a systematic review. PROSPERO REGISTRATION NUMBER: CRD42019137800.


Assuntos
Trombose Coronária/diagnóstico , Neoplasias Cardíacas/diagnóstico , Imagem por Ressonância Magnética/métodos , Trombose Coronária/diagnóstico por imagem , Diagnóstico Diferencial , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Projetos de Pesquisa , Sensibilidade e Especificidade
3.
Medicine (Baltimore) ; 98(49): e18193, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804339

RESUMO

RATIONALE: Primary cardiac angiosarcoma is a rare malignant cardiac neoplasm with early metastasis and poor prognosis. As there are currently no guidelines or effective therapeutic strategies, management of this condition depends on previous experiences of the clinician treating and the consideration of reported cases. PATIENT CONCERNS: A 65-year-old male presented to our department with a 4-day history of chest tightness, dyspnea, lower extremity weakness and occasional dizziness, and a transthoracic echo (TTE) revealed a right atrium occupying mass. DIAGNOSES: TTE showed right atrium occupation, and the post-operative histopathology showed the tumor to be a primary cardiac angiosarcoma. INTERVENTIONS: Right atrium tumor resection and right atrium reconstruction with a bovine pericardium were performed. OUTCOMES: The patient recovered from surgery and discharged but died 10 months after surgery because of complete resection was impossible and adjuvant therapy was not performed. LESSONS: Resection of primary cardiac angiosarcomas should be integrated with a combination of chemotherapy, radiotherapy, and targeted therapy based on tumor cell gene mutation and altered expression.


Assuntos
Neoplasias Cardíacas/patologia , Hemangiossarcoma/patologia , Idoso , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Masculino
4.
Medicine (Baltimore) ; 98(51): e18386, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861001

RESUMO

RATIONALE: Pulmonary embolisms (PEs) are caused by emboli, which mostly originate from deep venous thrombi that travel to and suddenly block the pulmonary arteries. The emboli are usually thrombi, and right atrial myxoma emboli are rare. PATIENT CONCERNS: A 55-year-old man presented with shortness of breath and syncope. We proceeded with computed tomography pulmonary angiography (CTPA) and transthoracic echocardiogram (TTE), the results of which suggested that the diagnosis was a right atrial mass. DIAGNOSIS: A definitive diagnosis compatible with a right atrial myxoma (RAM) with tumoral pulmonary emboli after surgical excision was made. INTERVENTION: Right atrial and pulmonary artery embolectomy. OUTCOMES: The patient followed an uneventful course during the 6 years of follow-up after surgery. According to a review of the literature, RAMs are often not diagnosed in a timely manner or even go completely undiagnosed. TTE, transesophageal echocardiography (TEE), CT, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography may be helpful in the preoperative diagnosis. Surgical removal of the masses from the atrium and pulmonary arteries was relatively uneventful. LESSONS: RAMs should be considered unlikely reasons for fatal pulmonary embolisms.


Assuntos
Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Embolia Pulmonar/etiologia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Embolia Pulmonar/cirurgia
5.
Medicine (Baltimore) ; 98(44): e17463, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689750

RESUMO

RATIONALE: Malignant peripheral nerve sheath tumor (MPNST) is a very rare sarcoma of the heart, and few cases have been reported. Herein, we retrospectively reviewed clinical manifestations, imaging features and management of our patient and other reported cases. PATIENT CONCERNS: A 32-year-old woman was referred to the emergency department of our institution with expiratory dyspnea, edema of face for a month. DIAGNOSIS: The patient was initially diagnosed with asthma at a local hospital based on a history of fatigue, cough and expiratory dyspnea, as well as negative electroencephalogram (ECG) and chest radiography. Based on computed tomography (CT) and cardiac magnetic resonance imaging (CMRI) in our hospital, she was found to have a malignant tumor involving right atrium. The tumor was diagnosed as MPNST according to histopathological results. INTERVENTIONS: The tumor was deemed unresectable during the surgery. Then, the patient was referred for chemotherapy and radiotherapy. OUTCOMES: The patient deteriorated and died 4 months later. LESSONS: Cardiac MPNST is very uncommon with nonspecific clinical and imaging characteristics according to limited cased reported. CMR, due to the high tissue resolution and multiple sequence imaging advantages, is useful for the detection, location and evaluation whether there is involvement of adjacent structures, and may help better clinical decision-making.


Assuntos
Neoplasias Cardíacas/diagnóstico , Neurofibrossarcoma/diagnóstico , Adulto , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/terapia , Humanos , Imagem por Ressonância Magnética , Neurofibrossarcoma/diagnóstico por imagem , Neurofibrossarcoma/terapia , Tomografia Computadorizada por Raios X
6.
J Cardiothorac Surg ; 14(1): 186, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690322

RESUMO

BACKGROUND: Cardiac hemangiomas are rare cardiac neoplasia usually diagnosed in autopsies, from being asymptomatic to debuting with sudden death. The largest hemangioma published in the literature is of 130 mm size, we present the following case of a successful cardiac hemangioma excision of 280 × 35 mm in size, diagnosed due to recurrent cardiac symptoms. CASE PRESENTATION: A 48-year-old female patient, Jehovah's Witness, with no previous diagnoses, is admitted due to recurrent syncopal episodes in the previous months. A transthoracic echocardiogram diagnosed a tumor in the right atrium and inferior vena cava producing a diastolic right ventricular, with preservation of the left ventricular ejection fraction at 55%. Given the high mortality risk, a surgical intervention was performed immediately. Successful excision was completed confirming a 280 × 35 mm mass without any complications, consistent with hemangioma on histopathology. Postoperative recovery showed no recurrence or complications. CONCLUSIONS: Cardiac hemangiomas are rare and its clinical course can be varied from patient to patient. We present excision of a large cardiac mass with a high mortality risk due to its size and the patient's spiritual beliefs.


Assuntos
Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Hemangioma/diagnóstico , Veia Cava Inferior , Diagnóstico Diferencial , Ecocardiografia , Feminino , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Humanos , Testemunhas de Jeová , Pessoa de Meia-Idade , Síncope/etiologia
7.
Medicine (Baltimore) ; 98(38): e17250, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567993

RESUMO

RATIONALE: Central retinal artery occlusion (CRAO) due to cardiac myxoma primarily occurs in elderly individuals. Early detection and surgical resection of myxoma are extremely important because CRAO causes complete blindness in most cases. However, due to the extremely low incidence of CRAO caused by cardiac myxoma in the pediatric age group, such condition is rarely reported. PATIENT CONCERNS: A 16-year-old female patient visited our hospital due to sudden onset of vision loss in the left eye, dysarthria, and right-sided hemiplegia. DIAGNOSES: She was diagnosed with CRAO via fundoscopy. Results showed a cherry-red spot, indicating CRAO. Brain magnetic resonance imaging (MRI) revealed multifocal diffusion-restricted foci, particularly in the left frontal lobe. Echocardiography revealed a left atrial mass measuring 4.21 cm × 2.25 cm. The mass was attached to the interseptum and moved along the inflow of the mitral valve. Cardiac computed tomography (CT) revealed an enhanced mass measuring 3 cm × 2.2 cm × 3 cm and with irregular margin on the anterior wall of the left atrium and the border of the fossa ovalis. INTERVENTIONS: The patient underwent surgical excision under general anesthesia. Intraoperative finding showed a huge, jelly-like, and extremely friable mass. Pathological examination confirmed myxoma. OUTCOMES: During a follow-up of 2 years after diagnosis, she did not present with other neurological deficits and no residual mass was observed on echocardiography. However, visual impairment of the left eye persisted. LESSONS: Most patients with CRAO may present with other mild symptoms that are often be neglected before CRAO development. We recommend that patients who present with frequent syncopal attack or symptoms of transient ischemic attack should undergo echocardiography.


Assuntos
Cegueira/etiologia , Átrios do Coração , Neoplasias Cardíacas/complicações , Mixoma/complicações , Adolescente , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Mixoma/diagnóstico por imagem , Mixoma/patologia , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Tomografia Computadorizada por Raios X
8.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(9): 731-736, 2019 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-31550845

RESUMO

Objective: To analyze the clinical, radiologic characteristics, and outcome of consecutive patients with primary cardiac angiosarcoma. Methods: The medical records of patients with primary cardiac angiosarcoma diagnosed through pathology at Peking Union Medical College Hospital between January 2001 and May 2018 were obtained. The results of echocardiography, coronary artery CT angiography (CTA), cardiac magnetic resonance (CMR), positron emission computed tomography (PET-CT), operation, postoperative treatment and prognosis of the patients were analyzed. Results: A total of 16 patients were included, 9 were male, 7 were female, the median age was 42.5 years (31.7, 52.5). The interval from symptoms onset to diagnosis was 4.5 months (0.5-18.0 months). Eight patients were diagnosed at non-metastatic phase, while 8 patients were in metastatic phase. The main complaints were dyspnea, short breath, chest pain, hemoptysis, syncope, edema, fever, fatigue, and cough. Three patients (18.8%) had pericardial tamponade in the course of the disease. Echocardiography was performed on all 16 patients, cardiac mass was found in 12 patients, and pericardial effusion or pericardial thickening was observed in 4 patients. In 8 cases with results of coronary CTA, 5 cases presented signs of right atrium occupation, 1 case presented sign of right ventricle occupation, and 1 case presented isolated massive pericardial effusion. None abnormality was found in 1 case. Of the 7 patients who underwent CMR, 6 presented with right atrium mass occupation and 1 mediastinal mass. Four patients received PET-CT examination and results showed that all presented with hypermetabolic lesions: 2 in right atrium, 1 in pericardium, and 1 in mediastinum, and lung metastasis was found in 2 cases. Among the 16 patients, 13 received surgical treatment, 2 received adjuvant chemotherapy, and 1 received chemotherapy and radiotherapy after biopsy. The median overall survival was 3.0 months. Conclusion: Cardiac angiosarcoma is a rare malignancy with poor prognosis, and echocardiography has only limited diagnostic value for angiosarcoma. CMR, CTA or PET-CT examinations could provide valuable clues for the diagnosis of this rare disease.


Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Hemangiossarcoma/diagnóstico por imagem , Adulto , Angiografia Coronária , Ecocardiografia , Feminino , Átrios do Coração , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prognóstico
9.
J Radiol Case Rep ; 13(7): 1-13, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31558962

RESUMO

Uterine intravenous leiomyomatosis is an uncommon tumor, usually arising from the uterus, with nodular masses which extend intravascularly over variable distances and may reach the inferior vena cava, right atrium, and pulmonary arteries. Early diagnosis and surgical intervention are crucial as intracardiac leiomyomatosis not only causes cardiac symptoms but may result in pulmonary embolism and sudden death. Complete tumor resection is key in disease management, thus rendering cardiac-extending uterine intravenous leiomyomatosis one of the most challenging conditions for surgical treatment. The use of interventional radiology procedures can facilitate the surgical approach. We report the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and pulmonary embolism, analyzing management and surgical outcomes, highlighting the role of interventional radiology during the therapeutic pathway. Nonetheless, there are currently very few data available concerning the use of interventional radiology procedures in the therapeutic strategy of uterine intravenous leiomyomatosis with intracardiac extension.


Assuntos
Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Leiomiomatose/complicações , Leiomiomatose/diagnóstico por imagem , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico por imagem , Ecocardiografia Doppler , Feminino , Coração/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Leiomiomatose/patologia , Leiomiomatose/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Neoplasias Uterinas/cirurgia , Útero/diagnóstico por imagem , Útero/cirurgia
11.
Braz J Cardiovasc Surg ; 34(4): 499-502, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454208

RESUMO

Cardiac papillary fibroelastoma are rare, benign cardiac tumors that may lead to lethal complications from embolization or valvular dysfunction if left untreated. When working up symptomatic tumors with concomitant angina, traditional diagnostic studies such as cardiac catheterization may predispose the patient to embolic complications if the mass is located in the path of the catheter. Newer, non-invasive diagnostic testing, such as cardiac magnetic resonance imaging or dynamic computed tomography angiography, may be considered in lieu of invasive approaches to avoid potentially devastating complications. We herein present a case report of a 77-year-old female with a symptomatic aortic valve tumor and describe our diagnostic strategy and management.


Assuntos
Valva Aórtica/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Idoso , Angiografia por Tomografia Computadorizada/métodos , Feminino , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Humanos
14.
J Clin Ultrasound ; 47(9): 568-571, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31392732

RESUMO

Primary cardiac tumors are rare, but papillary fibroelastoma (PFE) is reportedly the most common form, which usually occurs on the left-side valves of the heart. However, PFE involving the tricuspid and pulmonary valves has also been documented. Although PFE is benign and seldom associated with valvular dysfunction, the associated embolic complications may lead to serious consequences. Most patients with PFE lack specific clinical symptoms and the diagnosis is incidental. Surgical resection is the mainstay treatment for PFE in order to prevent the occurrence of embolic complications. In this report, we present a case of a rare asymptomatic PFE of the pulmonary valve, which was incidentally noted during a routine examination with transthoracic echocardiography (TEE). There was neither valvular dysfunction nor hemodynamic change. The PFE was surgically removed, and the diagnosis was further confirmed with histopathology.


Assuntos
Ecocardiografia/métodos , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Achados Incidentais , Valva Pulmonar/diagnóstico por imagem , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/cirurgia
16.
J Cardiothorac Surg ; 14(1): 142, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337436

RESUMO

BACKGROUND: Cardiac myxoma, a common benign primary tumor of the heart can be categorized into syndromic (Carney Complex) and non-syndromic(isolated). Carney Complex associated myxomas can be found in any region and system (cardiac, cutaneous, osseous, genitalia), and may manifest at a tender age. On the contrary, non-syndromic cardiac myxomas are usually confined to the chambers, and symptoms often present from 5th decade of life. Aortic valve myxoma is a very unusual occurrence, and presentation in a teen is extremely rare. CASE REPORT: We share a case of aortic valve myxoma, uncovered using echocardiography in a 16-year-old male, admitted with complaints of exertional chest pain, dyspnoea and systolic murmur. Patient underwent uneventful surgery for tumor excision, and discharged 6-days post operation. CONCLUSION: Given the high risk of developing cardiogenic stroke, infective endocarditis, degenerative effects on aortic valve leaflets and possible sudden death, like many other centers, we advocate for immediate liquidation of aortic myxoma regardless of age and symptoms.


Assuntos
Valva Aórtica , Complexo de Carney/diagnóstico , Neoplasias Cardíacas/diagnóstico , Adolescente , Angina Pectoris/etiologia , Complexo de Carney/complicações , Complexo de Carney/diagnóstico por imagem , Complexo de Carney/cirurgia , Diagnóstico Diferencial , Ecocardiografia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Masculino
18.
Braz J Cardiovasc Surg ; 34(3): 372-376, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310479

RESUMO

We are going to present a case of malignant fibrous histiocytoma in the right atrium, which is a very rare entity. The patient had a right atrial mass, which prolapsed through the tricuspid valve into the right ventricle, causing functional tricuspid valve stenosis. The tumor was completely resected and the patient had an uneventful postoperative period. Histopathological examination reported malignant fibrous histiocytoma. The patient presented to the emergency department five weeks after discharge with dyspnea and palpitation. Echocardiography and magnetic resonance imaging revealed recurrent right atrial tumor mass. His clinical status has worsened, with syncope and acute renal failure. On the repeated echocardiography, suspected tumor recurrence was observed in left atrium, which probably caused systemic embolization. Considering the aggressive nature of the tumor and systemic involvement, our Heart Council decided to provide palliative treatment by nonsurgical management. His status deteriorated for the next few days and the patient succumbed to a cardiac arrest on the 4th day.


Assuntos
Neoplasias Cardíacas/patologia , Histiocitoma Fibroso Maligno/patologia , Angiografia Coronária , Ecocardiografia , Evolução Fatal , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia , Doenças Raras , Tomografia Computadorizada por Raios X , Prolapso da Valva Tricúspide/diagnóstico por imagem , Prolapso da Valva Tricúspide/patologia
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