Methodist Journal

IN THIS ISSUE

Cardiovascular Imaging

Vol 16, Issue 2 (2020)


FEATURED GUEST EDITOR

ISSUE INTRO

Cardiovascular Imaging: A Window into Diagnostic and Therapeutic Management

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RECOGNITIONS

Guest Editor Dipan J. Shah Lends Expertise and Insight to Special Issue on Cardiovascular Imaging

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REVIEW ARTICLES See More

Cardiac Computed Tomography for Comprehensive Coronary Assessment: Beyond Diagnosis of Anatomic Stenosis

Cardiac Magnetic Resonance in Nonischemic Cardiomyopathies

Cardiac Computed Tomography for Structural Heart Disease Assessment and Therapeutic Planning: Focus on Prosthetic Valve Dysfunction

Fluorodeoxyglucose Applications in Cardiac PET: Viability, Inflammation, Infection, and Beyond

Cardiac Magnetic Resonance in Valvular Heart Disease: Assessment of Severity and Myocardial Remodeling

Patient-Specific Modeling for Structural Heart Intervention: Role of 3D Printing Today and Tomorrow

Artificial Intelligence in Cardiovascular Imaging

Myocardial Perfusion Imaging Using Positron Emission Tomography

CASE REPORTS See More

COVID-19: A Potential Risk Factor for Acute Pulmonary Embolism

Cardiac Lymphoma Presenting with Recurrent STEMI

Complete Heart Block in Systemic Sclerosis with Characterization on Cardiac MRI

Repair of Extent III Thoracoabdominal Aneurysm in the Presence of Aortoiliac Occlusion

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Collateral Arterial Pathways in Aortoiliac Occlusive Disease

An Interesting Cause of Eisenmenger’s Syndrome

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

Case-Based Points on the Role of Imaging in Kidney Disease

POINTS TO REMEMBER

Acute Kidney Injury in Cardiogenic Shock

EXCERPTA

Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg

POINTS TO REMEMBER

Onconephrology: An Evolving Field

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

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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Figure 3

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