Multimodal Imaging for the Assessment of a Cardiac Mass - A Case of Primary Cardiac Sarcoma

摘要

We present a case of an 85-year-old patient who underwent clinical work-up for chronic heart failure, acute coronary syndrome, and pulmonary embolism, until she was diagnosed with a cardiac mass that was histologically identified as sarcoma. The aim of this educational case report is to raise awareness of cardiac masses and to point out diagnostic hints towards a cardiac tumor on chest X-ray, coronary angiography, echocardiography, and chest CT. Moreover, the vital role of cardiac magnetic resonance for the diagnosis of a cardiac mass is highlighted. Keywords: cardiac mass, cardiac tumor, cardiac sarcoma, magnetic resonance imaging, MRI, cardiac MRI, cardiovascular MR, CMR, computed tomography, CT, echocardiography, coronary angiography, chest X-ray, multimodal imagingCASE REPORTAn 85-year-old woman presented to an outside hospital with dyspnea on exertion. Left-ventricular dilation was noted on her chest X-ray, a new finding compared to a chest X-ray four years before (Fig 1-A and 1-B). At echocardiography, mitral regurgitation was detected, and the patient was diagnosed with chronic heart failure (NYHA II–III). Her symptoms improved with diuretic medication so she could be discharged. Open in a separate windowFigure 1 85 y/o female with cardiac sarcoma.(1-A, B, C) Technique: Chest X-ray performed with CR 85-X, AGFA HealthCare, Bonn, Germany, 115 keV, automatic mAs.Findings: Chest X-ray 4 years ago (A), chest X-ray 4 months ago (B) and chest X-ray now (C) show an increase in heart size (arrows).(1-D) Technique: Coronary angiography performed with AXIOM-Artis, Siemens Healthcare, Forchheim, Germany.Findings: visualization of the right coronary artery (RCA) with posterolateral branch (PL), posterior descending artery (PD) and abnormal vessels (arrows) arising from a prominent right atrial branch (asterisk).(1-E) Technique: Chest computed tomography angiography (CTA) performed with GE Optima CT520 Series (100 kV, automatic mAs) in pulmonary artery phase after IV contrast injection of 70 mL iodinated contrast (Ultravist 300, Bayer HealthCare, Germany), slice thickness 2.5 mm.Findings: CTA shows a large left-pericardial mass (arrows) with hyperdense inclusions (asterisk), resembling calcifications.(1-F) Technique: Transesophageal echocardiography performed with CX50 Philips (X7-2T transducer, sector phased, 7–2 Mhz), Best, Netherlands.Findings: hyperechogenic mass adjacent to the left atrium (arrow), representing calcified tumor components.