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Mass confusion
M X Joseph1, Q G Forrest, S J Hutchison
1Echocardiography Laboratory, St Michael's Hospital, Toronto, Ontario, Canada.
Insights
A misdiagnosed cardiac tumor was revealed as high-grade lymphoma through advanced transesophageal echocardiography. This case highlights the importance of comprehensive echocardiography in diagnosing cardiac masses and their impact.
Area of Science:
- Cardiology
- Oncology
- Medical Imaging
Background:
- Initial diagnosis suggested benign arrhythmia and intracardiac tumor based on transthoracic echocardiography and initial transesophageal echocardiogram.
- Distinguishing benign cardiac masses from malignant tumors can be challenging with initial imaging modalities.
Observation:
- A patient presented with symptoms initially attributed to benign cardiac conditions.
- A subsequent, comprehensive transesophageal echocardiogram revealed extensive intra- and extracardiac masses with malignant features.
- Masses were observed to compress mediastinal vascular structures.
Findings:
- Peripheral biopsy confirmed a diagnosis of high-grade lymphoma.
- Comprehensive transesophageal echocardiography accurately defined the extent and location of the cardiac masses.
- Malignant features were identified, contrasting with typical myxoma characteristics.
Implications:
- Transesophageal echocardiography is crucial for detailed assessment of cardiac mass lesions and their physiological impact.
- Comprehensive echocardiographic evaluation, including spectral Doppler, aids in differentiating benign from malignant cardiac tumors.
- Early and accurate diagnosis through advanced imaging is vital for effective lymphoma treatment.
Abstract:
A patient is reported who presented to the hospital with a benign arrhythmia and what was initially believed to be a benign intracardiac tumour as imaged by transthoracic echocardiography and a first transesophageal echocardiogram. Comprehensive assessment with a second transesophageal echocardiogram revealed extensive extra- and intracardiac involvement by masses with many malignant-appearing features, including compression of vascular structures in the mediastinum. Peripheral biopsy yielded a diagnosis of high-grade lymphoma. The clinical, echocardiographic and radiological findings are discussed, as are the expected features of myxomae, and by comparison, common features of malignancy. The ability of transesophageal echocardiography, when comprehensively performed, to define the location and extent of mass lesions, and their physiological impact, such as compression of the pulmonary vasculature, by two-dimensional imaging and spectral Doppler are emphasized.