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Cardiac tumours simulating collagen vascular disease
Insights
Cardiac tumors can mimic autoimmune diseases, leading to misdiagnosis. Early recognition is crucial, as imaging may not rule out tumors, and some respond to initial treatments for autoimmune conditions.
Area of Science:
- Cardiology
- Rheumatology
- Pathology
Background:
- Cardiac tumors, both benign and malignant, can present with systemic symptoms mimicking collagen vascular diseases.
- Misdiagnosis can lead to delayed or inappropriate treatment for patients with cardiac tumors.
Observation:
- Three cases of cardiac tumors (two malignant, one benign) presented with symptoms resembling collagen vascular diseases.
- A review of 15 similar cases revealed misdiagnosis of various autoimmune conditions before the correct cardiac tumor diagnosis.
- In half of the reviewed cases, cardiac tumors were only identified post-mortem.
Findings:
- Collagen vascular disease diagnosis requires corroborative laboratory data; its absence warrants further investigation.
- Standard echocardiography (M-mode and cross-sectional) may not exclude malignant cardiac tumors or atrial myxomas.
- Some patients with suspected but unconfirmed autoimmune disease, who actually have cardiac tumors, may show improvement with steroid treatment.
Implications:
- Clinicians should consider cardiac tumors in patients with systemic upset and suspected collagen vascular disease, especially without laboratory confirmation.
- Advanced imaging and potentially biopsy may be necessary to definitively diagnose cardiac masses.
- This highlights the importance of a comprehensive diagnostic approach to avoid potentially fatal delays in cardiac tumor diagnosis.
Abstract:
Cardiac tumours can mimic collagen vascular disease and they are often accompanied by profound systemic upset. Both benign and malignant tumours may present in this way. Three cases of cardiac tumour, two malignant and one benign, are reported with just such a presentation. A review of fifteen similar case reports showed that a spectrum of different collagen vascular diseases was diagnosed and treated before the true diagnosis emerged. In half of these cases the cardiac tumour was only diagnosed at necropsy. The diagnosis of collagen vascular disease should not be made in the absence of corroborative laboratory data. In cases of malignant cardiac tumour, and less commonly with atrial myxoma, M mode and cross sectional echocardiography may not exclude the diagnosis. There may be a good response to steroid treatment in cases of suspected but not confirmed collagen vascular disease in which the true diagnosis is cardiac tumour.