Coronary embolisation of a left ventricular fibroelastoma mimicking a thrombus and triggering Takotsubo...

Area of Science:

• Cardiology
• Cardiac Pathology
• Cardiovascular Imaging

Background:

• Takotsubo cardiomyopathy (TTC) is often associated with emotional or physical stress.
• Left ventricular masses are typically presumed to be thrombi, especially in the context of myocardial infarction.
• Coronary artery embolisation can lead to acute myocardial infarction.

Purpose of the Study:

• To present an unusual case of Takotsubo cardiomyopathy triggered by a cardiac tumor.
• To highlight the diagnostic challenges in differentiating cardiac thrombi from tumors.
• To emphasize the importance of considering cardiac tumors in cases of unexplained myocardial ischemia.

Main Methods:

• Multimodality cardiac imaging (echocardiography, cardiac MRI) was used for diagnosis.
• Guideline-directed medical therapy for heart failure and anticoagulation were administered.
• Surgical resection of the ventricular mass was performed for definitive diagnosis.

Main Results:

• Initial diagnosis suggested Takotsubo cardiomyopathy with a left ventricular thrombus causing myocardial infarction.
• Persistent ventricular mass after anticoagulation prompted further investigation.
• Surgical resection revealed a fibroelastoma, leading to revised diagnosis of tumor emboli triggering TTC.

Conclusions:

• Cardiac tumors, particularly fibroelastomas in atypical locations, can cause coronary embolisation and myocardial ischemia.
• This case challenges the conventional assumption of thrombus in left ventricular masses associated with myocardial infarction.
• Clinicians should maintain a high index of suspicion for cardiac tumors in patients presenting with acute coronary syndromes without traditional risk factors.