Methodist Journal

IN THIS ISSUE

Adult Congenital Heart Update

Vol 15, Issue 2 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

The Growing Number of Adults Surviving with Congenital Heart Disease

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RECOGNITIONS

Drs. MacGillivray and Lin Take the Lead in Adult Congenital Heart Disease

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REVIEW ARTICLES See More

Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases

149 Fontan Conversions

Anomalous Aortic Origin of a Coronary Artery

Pulmonary Valve Replacement for Tetralogy of Fallot

Management of the Adult with Arterial Switch

Ebstein’s Anomaly

Heart Transplantation in Adults with Congenital Heart Disease

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

CASE REPORTS See More

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

Device-Related Thrombus: A Reason for Concern?

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

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do I Look Fat in This? Multimodality Imaging Findings of a Cardiac Lipoma

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

The Kidney in Congenital Cyanotic Heart Disease

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

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

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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