Usefulness of transesophageal echocardiography in evaluation of paracardiac neoplastic masses

doi:10.1016/0002-9149(92)91283-A

The American Journal of Cardiology

Volume 70, Issue 2, 15 July 1992, Pages 247-251

https://doi.org/10.1016/0002-9149(92)91283-A Get rights and content

Abstract

Mediastinal paracardiac tumors may cause both cardiovascular complications and problems in differential diagnosis of cardiac diseases. Transesophageal echocardiography (TEE) may give an additional new window to mediastinal neoplasms, but only a few studies have been reported. TEE was performed in 70 patients with paracardiac neoplastic masses. The procedure was indicated to solve particular clinical problems in 20 patients, and as a prospective study on 50 unselected patients with mediastinal neoplasms. Twenty-three patients underwent follow-up studies; a total of 101 echocardlograms were recorded. The procedure was tolerated well or very well by most patients, and provided additional anatomic or hemodynamic data in every patient in group a and in 45 of 50 in group b. The additional data were relevant for clinical management in 14 of 20 patients in group a, and in 3 of 45 in group b. Based on the results of this study, TEE is useful in association with other radiologic techniques in patients with paracardiac neoplasms. As an imaging technique, it may represent a reliable alternative to computed tomography whenever the latter is not feasible.

References (30)

WC Roberts et al.
Heart in malignant lymphoma (Hodgkin's disease, lymphosarcoma, reticulum cell sarcoma and mycosis fungoides): a study of 196 autopsy cases
Am J Cardiol
(1968)
IS Cohen et al.
Two-dimensional echocardiography in the detection of noneffusive cardiac involvement by intrathoracic neoplasms
Am Heart J
(1984)
C Lestuzzi et al.
Sensitivity and specificity of electrocardiographic ST-T changes as markers of neoplastic myocardial infiltration
Chest
(1989)
B Winter
Pulmonic stenosis produced by compression of heart by anterior mediastinal tumor
Am Heart J
(1958)
PT Moore et al.
Juxtacardiac mass and congestive heart failure
Chest
(1984)
M Cooke et al.
Mediastinal tumor causing continuous murmur
Am Heart J
(1984)
DS Halperin et al.
Intrathoracic neuroblastoma presenting with neonatal cardiorespiratory distress
Chest
(1984)
JE Connolly et al.
The differentiation of aneurysm and mediastinal tumor
J Thorac Cardiovasc Surg
(1960)
R Fox et al.
Detection by doppler echocardiography of acquired pulmonic stenosis due to extrinsic tumor compression
Am J Cardiol
(1984)
MC Hsiung et al.
Two-dimensional echocardiographic diagnosis of acquired right ventricular outflow obstruction due to external cardiac compression
Am J Cardiol
(1984)

GS Mintz et al.

Real-time two-dimensional echocardiography in differentiating vascular from nonvascular mediastinal lesions

Chest

(1982)

L Mancuso et al.

Echocardiographic recognition of mediastinal masses

Chest

(1988)

JB Seward et al.

Transesophageal echocardiography: technique, anatomic correlations, implementation, and clinical applications

RL Shuman

Primary pulmonary sarcoma with left atrial extension via left superior pulmonary vein. En bloc resection and radical pneumonectomy on cardicpulmonary bypass

J Thorac Cardiovasc Surg

(1984)

P Dartevelle et al.

Replacement of the superior vena cava with polytetrafluoroethylene grafts combined with resection of mediastinal-pulmonary malignant tumors

J Thorac Cardiovasc Surg

(1987)

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Citation Excerpt :
In this report, none of the known factors that were found associated with the occurrence of intramural atrial hematomas have been identified making the diagnosis of this case unique and worth studying. The echocardiographic finding of a cystic mass in this case raised the differential diagnosis of hydatidosis, a cystic myxoma, pseudocyst of the right atrial wall related to ventriculo-peritoneal shunts, external compression by neoplasms, and atrial dissection [9,10]. Clinically, the patient suffered from atrial fibrillation long before the current diagnosis.
Atrial intramural hematoma is a rare entity. It was reported to occur spontaneously especially in patients with recent history of cardiac surgery or cardiac trauma. In this report, a case of spontaneous intramural hematoma associated with large bloody stained pericardial effusion presented with progressive shortness of breath as the primary clinical manifestation is described. The diagnosis was tentatively achieved by transesophageal echocardiography and cardiac computed tomography scan and was later confirmed during surgery. The patient recovered uneventfully following surgery and follow-up echocardiography demonstrated complete resolution of pre-existing hematoma.
<Learning objective: We present a case of spontaneous intramural atrial hematoma and cardiac tamponade in a 61-year-old patient with a history of progressive shortness of breath. The proper diagnosis and surgical intervention are described. This case description will help increase the awareness regarding the diagnosis of this rare cardiac condition.>
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Non-Hodgkin's lymphoma (NHL) rarely presents initially with cardiac symptoms. In this case, its first symptom was a recurrent syncope. The diagnosis of mediastinal tumor was made with transesophageal echocardiography. Considerable compression of the left atrium and superior vena cava without intracardiac growth was a cause of the syncope. Tumor biopsy revealed a diffuse, high-grade, large B-cell NHL. The patient died after four cycles of chemotherapy. To our knowledge, no previous report has demonstrated a syncope as an initial presentation of mediastinal lymphoma not invading the heart.
Metastases to the heart
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Intracavitary lesions can also be detected with high sensitivity. In cases of peri- or paracardial lesions, the transesophageal approach is superior to the transthoracic approach [81, 84]. Supplemental diagnostic imaging methods are computer tomography and magnetic resonance imaging.
Diagnosis by magnetic resonance imaging of a case of intramural left atrial hematoma
2002, Revista Espanola de Cardiologia
Presentamos el caso de una paciente con hematoma intramural auricular izquierdo espontáneo que se manifestó con dolor torácico y edema pulmonar. Las técnicas ecocardiográficas objetivaron obstrucción al flujo auricular producido por masas de aspecto quístico en la pared posterior y anterior de la aurícula izquierda. Las imágenes con resonancia magnética demostraron un gran hematoma mural producido por disección extensa de la pared auricular. El diagnóstico de hematoma intramural se confirmó en una intervención quirúrgica sin complicaciones. Se revisa el perfil clínico y diagnóstico de los tres casos de hematomas intramurales espontáneos comunicados en la bibliografía.
We report a case of spontaneous intramural left atrial hematoma with chest pain and pulmonary edema as the primary clinical manifestations. Echocardiographic techniques revealed obstruction of the left atrial cavity by cyst-like masses attached to the posterior and anterior atrial wall. A large intramural hematoma due to extensive atrial wall dissection was observed by magnetic resonance imaging. Surgery confirmed the diagnosis of intramural left atrial hematoma with no complications. We review the clinical and diagnostic profile of the three cases of spontaneous intramural left atrial hematoma reported in the world medical literature.
Evaluation of mediastinal masses by endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration
2001, American Journal of Gastroenterology
Citation Excerpt :
Typically, lesions in the deep mediastinum have been examined and biopsied using either computerized tomography, magnetic resonance imaging, bronchoscopy or with mediastinoscopy/thoracotomy (4–6). With the advent of transesophageal echocardiography (7–10) and endoscopic ultrasound (EUS), the middle and posterior mediastinum have become accessible to ultrasonographic investigation. Since endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was introduced in the early 1990s (11–18), there has been a growing interest among gastroenterologists to play a larger role in the evaluation of mediastinal masses in general (19–22), as well as in the staging of lung cancer (21, 23, 24).
OBJECTIVE:
Interest has been growing in using endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the evaluation of mediastinal masses. The purpose of this study was to review the spectrum of mediastinal masses encountered using endoscopic ultrasound.
METHODS:
We reviewed all cases of mediastinal masses examined by endoscopic ultrasound, with or without endoscopic ultrasound-guided fine needle aspiration, prospectively gathered from our electronic database from April 1995 to July 2000.
RESULTS:
Of 1447 upper endoscopic ultrasound examinations, 33 (2.3%) involved a mediastinal mass. Sixty-one percent of the patients were male and the average age was 65 yr. Fifty-five percent of patients had dysphagia, 48 percent experienced weight loss, and only 12 percent were totally asymptomatic. Seventy-three percent had masses by chest CT. Sixty-seven percent were ultimately found to be malignant, 21 percent were solid benign lesions, and four were cystic. Only two lesions were resected. Endoscopic ultrasound-guided fine needle aspiration was used in 76 percent of all patients. The median survival of patients with malignant lesions was only 87 days.
CONCLUSIONS:
Lesions of the deep mediastinum are often difficult to conclusively diagnose with nonendoscopic studies. Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration can easily access this region to aid in the diagnosis and management of these lesions.
Caediac tamponade and pericardic mass as primary manifestations of a clinical pulmonary neoplasia
1998, Revista Espanola de Cardiologia
El taponamiento cardíaco y el hallazgo de unamasa aislada en la cavidad pericárdica como primeramanifestación de una neoplasia maligna de otralocalización es excepcional. Presentamos el caso deun paciente afectado de carcinoma pulmonar cuyaprimera manifestación clínica fue el desarrollo deun taponamiento cardíaco de rápida instauraciónen el contexto ecocardiográfico de una masa en cavidadpericárdica adherida a la aurícula izquierda.
Cardiac tamponade and the finding of a simplepericardic mass as the first manifestations of a malignantneoplasia from another location are exceedinglyrare events.
Here we present a patient affected with a lungcarcinoma whose first clinical manifestation wasthe developement of a cardiac tamponade that establisheditself quickly within the context of amass inside the pericardic cavity and adhered tothe left atrium.

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MiscellaneousUsefulness of transesophageal echocardiography in evaluation of paracardiac neoplastic masses

Abstract

Am J Cardiol

Am Heart J

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Am Heart J

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Am Heart J

Chest

J Thorac Cardiovasc Surg

Am J Cardiol

Am J Cardiol

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J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Miscellaneous
Usefulness of transesophageal echocardiography in evaluation of paracardiac neoplastic masses