Vol 30, No 5 (2023)
Image in Cardiovascular Medicine
Published online: 2023-10-27

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Diagnostic challenges of an atypical left ventricular mass

Juan Pablo Ricarte-Bratti12, Florencia Blason1, Julieta Lozita1, Guillermo Einer Allende123
Pubmed: 37933405
Cardiol J 2023;30(5):852-853.

Abstract

Not available

clinicAL CARDIOLOGY

IMAGE IN CARDIOVASCULAR MEDICINE

Cardiology Journal

2023, Vol. 30, No. 5, 852–853

DOI: 10.5603/cj.95731

Copyright © 2023 Via Medica

ISSN 1897–5593

eISSN 1898–018X

Diagnostic challenges of an atypical left ventricular mass

Juan Pablo Ricarte-Bratti12Florencia Blason1Julieta Lozita1Guillermo Einer Allende123
1Servicio de Cardiología, Sanatorio Allende, Córdoba, Argentina
2Cátedra de Farmacología, Universidad Nacional de Córdoba, Córdoba, Argentina
3Cátedra de Clínica Médica I, Hospital Córdoba, Universidad Nacional de Córdoba, Córdoba, Argentina

Address for correspondence: Juan Pablo Ricarte Bratti, MD, PhD, Servicio de Cardiología, Sanatorio Allende, Ituzaingó 755, Córdoba, Argentina, tel: +5493516163895, e-mail: jpricartebratti@gmail.com

Received: 21.05.2023 Accepted: 9.08.2023

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

A 45-year-old female with a history of cervical cancer 2 years ago with complete remission consulted for dysarthria associated with a decrease in the left visual field. A brain magnetic resonance imaging (MRI) was performed where the diagnosis of ischemic stroke was reached by images compatible with embolic lesions, for which she was admitted to the coronary unit.

The echocardiogram revealed normal ejection fraction and an intracavitary mass was observed in relation to the chordae tendineae, with an area of greater volume at the lateroapical level (26 × 19 mm), with at least three hypermobile portions: one apical and two at the subvalvular level, compatible with thrombus (Fig. 1A, B).

After 1 week with heparin treatment, the patient evolved with worsening neurological symptoms, and a new brain MRI showed new embolic-ischemic foci.

A heart MRI was performed, finding two isointense images, intracavitary in the left ventricle at the apical lateral level and another smaller one, at the level of the tendinous chords of the mitral valve (Fig. 1C, D).

It was believed that these images in the left heart could be related to previous cervical cancer, so an 18 fluorodeoxyglucose positron emission tomography/computed tomography was performed. This illustrated hypermetabolic lesions in the left ventricle (Fig. 1E, F), both lungs, liver, spleen and vertebrae. The patient was evaluated by the oncology service and is currently undergoing chemotherapy treatment. It was therefore concluded that the images, initially interpreted as thrombus, were secondary tumor implants.

Figure 1. Imaging approach of intracavitary mass. Transthoracic echocardiogram; A. Four-chamber view; B. Three-chamber view, cardiac magnetic resonance; C. Four-chamber cine sequence; D. Four-chamber T2 STIR sequence; E. Cross section of the combined computed tomography and positron emission tomography image; F. Positron emission tomography with 18F-fluorodeoxyglucose cross section at the thoracic level.
Conflict of interest: None declared