Methodist Journal

IN THIS ISSUE

Lipids and Lipoproteins

Vol 15, Issue 1 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

Lipids and Cardiovascular Disease: Putting it All Together

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RECOGNITIONS

Guest Editors Henry Pownall and Antonio Gotto Offer Insight and Expertise on the topic of Lipids and Cardiovascular Disease

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REVIEW ARTICLES See More

Cholesterol: Can’t Live With It, Can’t Live Without It

How Much Do Lipid Guidelines Help the Clinician? Reading Between the (Guide)lines

Statins: Then and Now

Poststatin Lipid Therapeutics: A Review

HDL and Reverse Cholesterol Transport Biomarkers

Revisiting Reverse Cholesterol Transport in the Context of High-Density Lipoprotein Free Cholesterol Bioavailability

High-Density Lipoprotein Subspecies in Health and Human Disease: Focus on Type 2 Diabetes

Gene Delivery in Lipid Research and Therapies

CASE REPORTS See More

Device-Related Thrombus: A Reason for Concern?

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

Loperamide Mimicking Brugada Pattern

Reversed Pulsus Paradoxus in Right Ventricular Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Transcatheter Embolization of a Persistent Vertical Vein: A Rare Cause of Left-to-Right Shunt and Right-Sided Heart Failure

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

Addressing the Feedback Loop Between Depression, Diabetes, and Cardiovascular Disease

POINTS TO REMEMBER

The Kidney as an Endocrine Organ

EXCERPTA

The Other Side of the Prescription

EDITORIALS

Addressing the Underrepresentation of Women in Cardiology through Tangible Opportunities for Mentorship and Leadership

Vol 14, Issue 4 (2019)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

A Right Ventricular Mass

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Article Citation:

Marin-Acevedo JA, Chirila RM. A Right Ventricular Mass. Methodist DeBakey Cardiovasc J. 2018;14(4):303.



Keywords
right ventricular mass , cardiac tumor , cardiac metastasis , transthoracic echocardiogram ,  cardiac magnetic resonance , cardiac imaging , TTE , CMR

A 60-year-old male presented with a 2-day history of progressive dyspnea. Three months prior to presentation, he was diagnosed with a left calf undifferentiated pleomorphic sarcoma. He had known pulmonary and bony metastases and was receiving systemic chemotherapy with doxorubicin. Physical examination revealed tachypnea, tachycardia, and a left calf mass. A computed tomography (CT) of the chest revealed new bilateral small pulmonary emboli (yellow arrow) and a right ventricular (RV) mass (Figure 1, red arrow). A transthoracic echocardiogram (TTE) showed a large solid mass (arrow) that obliterated the RV apex (Figure 2). Cardiac magnetic resonance (CMR) confirmed the presence of a gadolinium-enhancing mass consistent with metastasis (Figure 3, arrows). The patient was started on anticoagulation for pulmonary embolism and on a new line of chemotherapy with gemcitabine and docetaxel.

Whereas primary cardiac tumors are rare and mostly benign, metastatic cardiac involvement is silent and occurs in up to 9% of patients with known malignancies. Cardiac tumors have been reported in up to 25% of autopsies of patients with soft-tissue sarcomas. In practice, cardiac metastatic involvement is incidentally found by staging imaging. Diagnostic evaluation involves different modalities: TTE is useful for initial evaluation, and transesophageal echocardiogram allows a more comprehensive evaluation; CT offers anatomic details of the mass and detects extracardiac involvement; and CMR identifies the precise location and pericardial invasion. Managing these lesions often requires palliative chemotherapy and/or radiotherapy. Surgery is usually reserved for life-threatening complications. Unfortunately, prognosis is poor despite treatment, and overall survival ranges from 6 to 12 months.

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