A case series of ventricular cystic masses

Abstract

Background Ventricular cystic masses are uncommon. Elucidating the cause is essential for early directed therapy and prevention of complications. We present two cases of ventricular cystic masses, one in each ventricle, after myocardial infarction (MI) and ventricular septal rupture (VSR), respectively. Case summary Patient 1 is a 58-year-old male with left brachio-facial stroke and evolved anterior MI. A left ventricular (LV) cystic thrombus was seen on transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) imaging. He was started on anticoagulation with reduction in thrombus size 11 days later. Patient 2 is a 67-year-old male with evolved anterior MI, severe LV systolic dysfunction, and normal right ventricular (RV) function. He was readmitted two weeks later with fever, heart failure, Streptococcus agalactiae bacteraemia, and septic pulmonary emboli. Transthoracic echocardiogram showed biventricular systolic dysfunction and a RV cystic mass associated with a partial VSR. He was treated with anticoagulation and antibiotics. Repeat TTE 5 weeks later revealed near resolution of the cystic mass and complete VSR. Cardiac magnetic resonance confirmed these findings and also showed a localized mid-septal transmural infarction at the VSR site. He underwent percutaneous coronary intervention to the left anterior descending and circumflex arteries, and percutaneous VSR closure with a muscular ventricular septal defect device later. Discussion Our two cases demonstrate that ventricular thrombi can present as cystic masses after MI and VSRs. Infectious, vascular, or oncogenic causes should be considered in the appropriate clinical context. Early diagnosis and treatment is essential to prevent embolic complications, and secondary infection.

Left ventricular outflow tract cyst: What was it and where did it go?

“…4,6 Normally, thrombus forms secondary to an underlying abnormality or hypercoagulability, as stasis is not really seen in a normal heart (Virchow’s triad of blood stasis, hypercoagulability and endothelial injury). 5 Early diagnosis and treatment are important as embolic complications may result if thrombi are left untreated, but unfortunately embolic complications may be the presenting feature (as in our case). Although anticoagulation is the treatment of choice (3–6 months), some patients may have contraindications to this modality of treatment, and cardiac surgery may be necessary to remove the lesion.…”

“…Cardiac cystic masses are uncommon and are usually seen in association with underlying cardiac/valvular pathology 4,5 such as post-myocardial infarction. Cyst or thrombus formation in the LVOT of a normal heart is a very rare occurrence, and we can find no such cases in the literature.…”

Fatal Sinus of Valsalva Aneurysm and Dissection into the Left Ventricle With Extension to the Interventricular Septum: A Challenging Diagnosis

“…The clinical context and characteristics of the masses help establish the most accurate diagnosis. 7 …”