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Cardiac Excrescences of Unusual Origin
Jason R Stuck1, Amgad N Makaryus2,3
1PinnacleHealth CardioVascular Institute, 1000 North Front Street, Wormleysburg, PA 17043, USA.
Abstract:
Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) are a rare finding that are most often discovered incidentally either upon echocardiography or invasive cardiovascular procedures. In total, less than 50 known cases have been reported since first being discovered over 30 years ago. They are typically benign lesions; however, there has been a reported case of cardiac MICE being responsible for severe cardiopulmonary compromise and another case of the lesion embolizing leading to cerebral infarctions and ultimately death. Cardiac papillary fibroelastomas are also uncommon lesions found in the heart though they are not as rare as cardiac MICE. They are also benign and are typically attached to valvular surfaces; however, they also can be found as mobile masses. Just as cardiac MICE, they are capable of causing turbulent flow and thrombus formation and have been reported as the cause of ischemic events due to their ability to embolize. We present a case of cardiac MICE and cardiac papillary fibroelastoma in an individual who initially presented with neurologic symptoms concerning for a cerebrovascular accident. The patient was found to have a left ventricular mass composed of both cardiac MICE and cardiac papillary fibroelastomas.
Insights
This case report details a rare co-occurrence of cardiac MICE (mesothelial/monocytic incidental cardiac excrescences) and cardiac papillary fibroelastoma. The combined lesions presented as a left ventricular mass, initially causing neurologic symptoms.
Area of Science:
- Cardiology
- Pathology
- Neurology
Background:
- Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) are rare, typically benign cardiac tumors, with fewer than 50 reported cases.
- Cardiac papillary fibroelastomas are also uncommon benign tumors, often found on heart valves, capable of embolization and causing ischemic events.
- Both cardiac MICE and papillary fibroelastomas can lead to serious complications, including thromboembolism and hemodynamic compromise.
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