Multimodality cardiac magnetic resonance imaging of cardiac mass




Abbreviations



AVR


aortic valve replacement


CABG


coronary artery bypass graft


CT


computed tomography


TTE


transthoracic echocardiography



An 84-year-old man presented with a 1-month history of dyspnoea and constrictive chest pain on exertion, relieved by nitroglycerin administration. His main medical history included aortic valve replacement (AVR) with a bioprosthetic valve, coronary artery bypass graft (CABG) and post-transfusion chronic hepatitis C. Physical examination was normal except for a grade 2 ejection systolic murmur audible in the aortic area and bilateral leg oedema. Electrocardiogram demonstrated sinus rhythm at 75/min and T-wave inversion in the inferior leads. Moderately elevated troponin concentration was noted (0.79 μg/L). The patient was transferred to the intensive care unit with a preliminary diagnosis of acute coronary syndrome.


Transthoracic echocardiography (TTE) revealed a hyperechogenic and heterogeneous motionless mass infiltrating the lateral wall of the right ventricle and atrium ( Fig. 1 , Panel A, black arrow) without intracavitary extension. Left ventricular ejection fraction was normal.




Figure 1


Panel A. Transthoracic echocardiography revealing a hyperechogenic and heterogeneous motionless mass infiltrating the lateral wall of the right ventricle and atrium without intracavitary extension. Panel B. Cardiac magnetic resonance: T2-weighted black blood spin echo sequence confirming a tumor involving the right free wall of the heart, centred on the atrioventricular groove. Panel C. Cardiac magnetic resonance: fat suppressed T2-weighted black blood spin echo sequence showing an increased signal. Panel D. Cardiac magnetic resonance: first-pass perfusion imaging showing early enhancement. Panel E. Cardiac magnetic resonance: patchy delayed enhancement after gadolinium injection. Panel F. cardiac CT showing right coronary artery encasement by the tumour. Panel G. CT guided biopsy of the tumour. Panel H. Microscopic view: diffuse large B-cell lymphoma.

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Jul 17, 2017 | Posted by in CARDIOLOGY | Comments Off on Multimodality cardiac magnetic resonance imaging of cardiac mass

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