Left atrial tumour mimicking pulmonary embolism

Seal, Eric; Rutter, Harry; Horrigan, M.; Britton, Mark

doi:10.1016/s0954-6111(97)90091-3

Cited by 7 publications

(6 citation statements)

References 6 publications

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“…The diagnostic sensitivities of transthoracic and transesophageal echocardiography are 93.3% and 96%, respectively [31]. However, cases have been described where cardiac sarcomas have eluded diagnosis by echocardiography and were eventually demonstrated by CT or by open tumour biopsy [32,33] TOE guides transvenous tumour biopsies especially with right atrial masses [34], thereby avoiding invasive diagnostic procedures [35].…”

Section: Echomentioning

confidence: 99%

Primary cardiac sarcoma

Shanmugam¹

2006

European Journal of Cardio-Thoracic Surgery

132

157

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Primary malignant lesions of the heart are rare. Although myxomas have been extensively described, there is a paucity of large studies on non-myxomatous cardiac tumours. On the other hand, there are several case reports on specific histopathological variants, in small numbers. Consequently there exists no consensus on therapeutic modalities for cardiac sarcomas. The prognosis for these lesions remains dismal, despite the enhanced diagnostic ability of newer technology. The reasons for the dismal prognosis are (1) the advanced tumour stage at presentation, (2) non-specific symptomatolgy, (3) insufficient awareness of these lesions, due to their rarity, (4) delayed diagnosis and/or misdiagnosis, which leads to (5) advanced tumour stage at presentation. Thus a vicious cycle is created. This article addresses these issues, deals with the surgically relevant modes of presentation, rather than the histopathology, and reviews the diagnosis and management options for the various sarcomas, categorized by the site and extent of cardiac involvement. Clinicians should be familiar with the presentation of these tumours and have a high index of suspicion, since the potential for long-term survival following resection does exist. Wide surgical resection remains the cornerstone of sarcoma therapy. Complete characterization of tumour extent using echocardiography and CT/MRI is mandatory to achieve this goal. Radical resections such as 'bench surgery' and transplantation may reduce local recurrence, but the risk of metastatic disease remains. The clinical experience with such approaches is limited. The role of adjuvant therapy is not yet established. In no other field of cardiac surgery would a multidisciplinary approach be more useful, in achieving cure or long-term palliation.

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Section: Echomentioning

confidence: 99%

Primary cardiac sarcoma

Shanmugam¹

2006

European Journal of Cardio-Thoracic Surgery

132

157

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“…At CT, low-attenuation tumor may obliterate entire chambers (72,73). Some reports have described necrotic areas in gross pathologic specimens (69), and others have described a similar appearance at CT (74).…”

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confidence: 99%

CT and MR Imaging of Primary Cardiac Malignancies

Araoz¹,

Eklund²,

Welch³

et al. 1999

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203

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Primary cardiac malignancies are rare tumors that are difficult to diagnose clinically. Different primary cardiac malignancies may have different clinical, morphologic, and radiologic features and intracardiac locations. Angiosarcoma is the most common primary cardiac malignancy. It tends to occur in the right atrium and involve the pericardium. Because of its tendency to hemorrhage, angiosarcoma often demonstrates areas of increased signal intensity with T1-weighted sequences. Undifferentiated sarcomas typically occur in the left atrium and have variable epidemiologic and radiologic features. Rhabdomyosarcoma is the most common primary cardiac malignancy in children and is more likely than other primary cardiac sarcomas to involve the valves. Primary cardiac osteogenic sarcoma almost always occurs in the left atrium and frequently demonstrates calcification. Certain features (eg, broad base of attachment, origin at a site other than the atrial septum) help differentiate this tumor from left atrial myxoma. Leiomyosarcoma favors the left atrium and tends to invade the pulmonary veins and mitral valve. Fibrosarcoma also tends to occur in the left atrium and is often necrotic. Liposarcoma is very rare and usually manifests as a large, infiltrating mass. Foci of macroscopic fat are occasionally seen. Primary cardiac lymphoma occurs more commonly in immunocompromised patients, frequently involves the pericardium, and, unlike other primary cardiac malignancies, may respond to chemotherapy. The advent of cross-sectional imaging has allowed earlier detection of primary cardiac malignancies as well as more accurate diagnosis and characterization.

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“…In one example, a large hemorrhagic angiosarcoma infiltrated the right atrium and ventricle, but a series of successive echocardiograms did not suggest an intracardiac tumor 6 . In another report, a left atrial high‐grade fibrosarcoma occupying the entire left atrium and obstructing pulmonary venous inflow was missed on transthoracic echocardiography and was revealed only by a transesophageal study 7 …”

Section: Discussionmentioning

confidence: 99%

Large Obstructive Cardiac Myxofibrosarcoma Is Nearly Invisible on Transthoracic Echocardiogram

Heletz

Abramson

2009

Echocardiography

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Malignant primary cardiac tumors are exceptionally rare, and the most common of these are sarcomas. We present a case of a patient who was found to have a large mass in the left atrium causing obstruction of mitral inflow. Only selected views on a transthoracic echocardiogram reveal the mass and its hemodynamic effect. Although the mass was sizeable, it could be easily overlooked on cursory review of the echocardiogram. After surgical resection, the mass was proven to be a myxofibrosarcoma. We review the etiologies and possible solutions for the imperfect sensitivity of transthoracic echocardiography for cardiac masses.

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Left atrial tumour mimicking pulmonary embolism

Cited by 7 publications

References 6 publications

Primary cardiac sarcoma

Primary cardiac sarcoma

CT and MR Imaging of Primary Cardiac Malignancies

Large Obstructive Cardiac Myxofibrosarcoma Is Nearly Invisible on Transthoracic Echocardiogram

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