Urmeneta Ulloa Javier, Martínez de Vega Vicente, Forteza Gil Alberto, Cabrera José Ángel
Cardiology Department, Hospital Universitario Quirónsalud, 28223 Madrid, Spain.
Radiology Department, Hospital Universitario Quirónsalud, 28223 Madrid, Spain.
Eur Heart J Case Rep. 2022 Jul 29;6(8):ytac315. doi: 10.1093/ehjcr/ytac315. eCollection 2022 Aug.
Benign cardiac tumours are infrequent in clinical practice and, of these, cardiac myxoma is the one with the highest incidence. Given that a left intraventricular presentation is rare, other differential diagnoses such as papillary fibroelastoma should be considered.
A 73-year-old woman patient with cardiac mass detected in transthoracic echocardiography (TTE) after a transient ischaemic attack. At TTE 2D-3D, a left intraventricular mass anchored at the level of the anterolateral papillary muscle was detected. Subsequently, cardiac magnetic resonance (CMR) was performed for mass characterization. This revealed behaviour in T1 (isointense with respect to myocardium), T2 (hyperintense), very prolonged T1-mapping (1848 msg), and T2-mapping (161 msg) values, without gadolinium uptake in the first-pass perfusion sequence, but with intense uptake in late enhancement sequences. Previous findings were compatible with a diagnosis of papillary fibroelastoma. The mass was resected intraoperatively and, although its macroscopic appearance pointed to a diagnosis of cardiac myxoma, it was finally confirmed to be a papillary fibroelastoma by pathological anatomy.
In cases where the size of the mass and its mobility allow tissue characterization by CMR, a diagnosis of papillary fibroelastoma and its differentiation with cardiac myxoma are feasible by this cardiac imaging technique.
良性心脏肿瘤在临床实践中较为罕见，其中心脏黏液瘤的发病率最高。鉴于左心室内出现的情况罕见，应考虑其他鉴别诊断，如乳头状纤维弹性瘤。
一名73岁女性患者，在短暂性脑缺血发作后经胸超声心动图（TTE）检查发现心脏有肿块。在TTE二维-三维检查中，发现左心室内有一个肿块，附着在前外侧乳头肌水平。随后，进行了心脏磁共振成像（CMR）以对肿块进行特征描述。结果显示在T1加权像上（与心肌等信号）、T2加权像上（高信号）、T1映射值（1848毫秒）和T2映射值（161毫秒）非常延长，首过灌注序列中无钆摄取，但延迟强化序列中有强烈摄取。先前的检查结果符合乳头状纤维弹性瘤的诊断。该肿块在术中被切除，尽管其大体外观提示心脏黏液瘤的诊断，但最终经病理解剖确诊为乳头状纤维弹性瘤。
在肿块大小及其活动度允许通过CMR进行组织特征描述的情况下，通过这种心脏成像技术对乳头状纤维弹性瘤进行诊断及其与心脏黏液瘤的鉴别是可行的。
