An Unusual Case of Cardiac Mass: A Multimodal Approach in Diagnosis and Treatment.
Ljiljana Rankovic-NicicMilica Dragicevic-AntonicZelimir AntonicVladimir MihajlovicMasa PetrovicBiljana MiličićGordana StamenkovicSvetislav PelemisMilovan BojicPublished in: Healthcare (Basel, Switzerland) (2024)
Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass' blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment.
Keyphrases
- mitral valve
- left ventricular
- left atrial
- computed tomography
- left atrial appendage
- heart failure
- pain management
- randomized controlled trial
- contrast enhanced
- high resolution
- pulmonary hypertension
- pulmonary artery
- optical coherence tomography
- rheumatoid arthritis
- magnetic resonance imaging
- early onset
- magnetic resonance
- single cell
- combination therapy
- coronary artery disease
- physical activity
- mass spectrometry
- coronary artery
- ultrasound guided
- pulmonary arterial hypertension
- drug induced
- electronic health record
- clinical decision support