Lee Wei-Chieh, Huang Min-Ping, Fu Morgan
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University. College of Medicine, 123, Ta Pei Road, Kaohsiung City, 83301, Taiwan.
Division of General Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 123, Ta Pei Road, Kaohsiung City, 83301, Taiwan.
J Med Case Rep. 2015 Aug 26;9:179. doi: 10.1186/s13256-015-0650-4.
The incidence of multiple intracardiac mass is rare. The differential diagnosis of intracavitary mass lesions includes benign, malignant primary, secondary metastatic cardiac tumors, or thrombus.
We report the case of a 49-year-old Asian woman, who experienced a 2-week history of progressive exertional dyspnea, orthopnea, bilateral lower limb edema and palpitations. Transthoracic echocardiography showed one fixed round hyperechoic mass with central necrosis over the left ventricular apex, one oscillating hyperechoic nodule over the anterior mitral annulus and one irregularly heterogeneous mass bulging out from the lateral wall of the right atrium. The incidence of multiple myxomas is rare. Unfortunately, high tumor marker, serum lactic dehydrogenase and serum uric acid levels were also present. We could not differentiate between diagnoses of multiple myxomas with thrombi or multiple metastatic tumors.
Primary intracardiac tumors are rare. Approximately 75% are benign, and approximately 50% are myxomas, which have an incidence of 0.0017% in the general population. Multiple intracardiac myxomas account for less than 5% of all cases of myxoma. Our case was an atypical picture of right atrial (RA) myxoma, as it was located in the RA lateral wall and extended to the RA auricle at the junction among the superior and inferior vena cava. Two masses in the left ventricle (LV) were thrombi and resolved after heparinization. Initially, elevated tumor markers and high serum uric acid and high serum lactic dehydrogenase levels were related to necrotic tumor-derived tissue, decompensated heart failure with pleural effusion and renal insufficiency. We share our experience of multiple intracardiac masses. Whether the intracardiac mass is benign or malignant, we recommend surgery due to the possibilities of systemic or pulmonary massive embolism, infection, arrhythmia and sudden death if the thrombus ruptures or the mass dislodges.
心脏内多发肿块的发生率很低。心腔内肿块病变的鉴别诊断包括良性、原发性恶性、继发性转移性心脏肿瘤或血栓。
我们报告一例49岁亚洲女性病例，患者有2周进行性劳力性呼吸困难、端坐呼吸、双侧下肢水肿和心悸病史。经胸超声心动图显示左心室心尖部有一个固定的圆形高回声肿块伴中央坏死，二尖瓣前瓣环处有一个摆动的高回声结节，右心房侧壁有一个不规则的不均匀肿块突出。多发黏液瘤的发生率很低。不幸的是，患者还出现了肿瘤标志物、血清乳酸脱氢酶和血清尿酸水平升高。我们无法区分多发黏液瘤与血栓或多发转移性肿瘤的诊断。
原发性心脏肿瘤很少见。约75%为良性，约50%为黏液瘤，在普通人群中的发生率为0.0017%。心脏内多发黏液瘤占所有黏液瘤病例的不到5%。我们的病例是右心房黏液瘤的非典型表现，因为它位于右心房侧壁并延伸至上下腔静脉交界处的右心耳。左心室内的两个肿块为血栓，肝素化后消失。最初，肿瘤标志物升高以及血清尿酸和血清乳酸脱氢酶水平升高与坏死的肿瘤组织、伴有胸腔积液和肾功能不全的失代偿性心力衰竭有关。我们分享了我们对心脏内多发肿块的经验。无论心脏内肿块是良性还是恶性，由于如果血栓破裂或肿块脱落可能发生全身或肺大块栓塞、感染、心律失常和猝死，我们建议进行手术。
