A young man aged 32 was referred to our Center due to suspicion of a thrombus in the left ventricle (LV), based on ambulatory echocardiogram. The patient had no history of chronic diseases and had unremarkable family history. He had been complaining of nonspecific chest pain for a few months. Ambulatory electrocardiogram (ECG) was normal and physical examination did not reveal any abnormalities. Chest X-ray showed no significant pathologies. Transthoracic echocardiography (TTE) showed an additional, mobile structure in the LV apex, which at first, raised a suspicion of a thrombus and was the reason for referring the patient to cardiology department. On presentation the patient was in good general condition, hemodynamically stable, complaining of a stabbing chest pain of a several months duration. Baseline 12-lead ECG revealed sinus rhythm 60/bpm, normal cardiac axis, ST-segment elevation up to 1 mm in the inferior and lateral leads. Serum markers of cardiac necrosis were within normal range (high-sensitivity troponin 0.005 ng/ml [N <0.014 ng/ml] and creatine kinase (, N-terminal pro-B-type natriuretic peptide [NT-proB-NP] was 5 pg/ml [N <125.0 pg/ml], while the level of D-dimers was 125 ng/ml [N <500 ng/ml]. Other laboratory tests including blood cell morphology, electrolytes, serum creatinine level, aminotransferases were also within normal ranges.TTE study showed an additional, spherical, balloting structure, measuring 1 × 1.2 cm, suspended on a fibrous band in the LV apex (Figure 1, 2). The structure had a smooth surface and uniform morphology. However, it became enhanced after intravenous echocardiography contrast injection (Figure 3). Dimensions, morphology and function of the cardiac chambers and valves were normal and small amount of fluid was found in the pericardium (4 mm behind the inferior wall).Cardiac magnetic resonance (CMR) imaging performed which confirmed additional, mobile, spherical mass, sized 10 × 8 × 11 mm, suspended on a fibrous band, that was attached to the intraventricular septum and lateral wall, in the upper one-third of the LV. The structure had isointense signal in steady-state free precession imaging and strong signal on T1-weighted, and T2-weighted images (Figure 4, 5). Moreover, it exhibited strong enhancement in LE and T1 Fat-Sat images, after gadolinium contrast injection ( Figure 6). The surrounding walls of LV and the additional string displayed normal CMR signal. There were no visible late gadolinium enhancement (LGE) areas of the myocardium. The images of the structure obtained via CMR were atypical for thrombus, and suggested a tumor.
AbstractCardiac tumors are relatively rare, and their differential diagnosis is usually challenging. We present the case of a young man complaining of nonspecific chest pain, who was admitted to the Cardiology Department due to suspicion of a thrombus in the left ventricle (LV). Transthoracic echocardiography showed an additional mobile structure located in the apex of the LV. For further investigation cardiac magnetic resonance imaging was p...