Alamro Bandar, Pergola Valeria, Eltayeb Abdalla, Alshammari Amal, Kholaif Naji, Alhamshari Ahmad, Al Admawi Mohammed, Mohammed Shamayel, Khaliel Feras, Galzerano Domenico
The Heart Centre, King Faisal Specialist Hospital and Research Center, Riyadh; College of Medicine, Alfaisal University, Riyadh.
Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua.
Monaldi Arch Chest Dis. 2023 Sep 19;94(3). doi: 10.4081/monaldi.2023.2768.
Nowadays, the diagnosis of cardiac myxomas (CM), particularly the histological types, remains a challenge. Two-dimensional (2D) transthoracic (TT) and transesophageal (TEE) echocardiography (ECHO) represent the first steps in the imaging pathway. 3D ECHO, implemented in imaging practice, appears to be an emerging diagnostic technique that overcomes some of the limitations of 2D ECHO while integrating the information provided by magnetic resonance (MRI). However, its role in the imaging arena is still debatable. Analyzing 17 myxomas in 13 patients, the study uncovers a diverse anatomical spectrum. Classical CM morphology is a minority, with most myxomas being sessile and originating from unexpected locations (right ventricular outflow tract and left atrial appendage). Texture and size variations are also noted. Comparing imaging, 2D TEE outperforms 2D TT in visualizing anatomical features, especially attachment types. 3D TEE confirms 2D TT findings and offers more detailed assessments, identifying peduncles missed in four cases by 2D TEE. Two small recurrent myxomas were exclusively detected by 3D TEE, not by 2D TEE or MRI. Two patients have papillary myxomas, and one has an embolism. Another patient with a solid myxoma also suffers an embolism, with a clot found at the apex during surgery. Our study showed that CM has a wide anatomical spectrum beyond the typical features, making the diagnosis challenging. Therefore, a multimodality imaging approach is essential for distinguishing CM from other cardiac masses and differentiating myxoma histological types. These findings stress the importance of incorporating 3D ECHO alongside other imaging techniques for a comprehensive evaluation.
如今，心脏黏液瘤（CM）的诊断，尤其是组织学类型的诊断，仍然是一项挑战。二维（2D）经胸（TT）和经食管（TEE）超声心动图（ECHO）是成像流程的第一步。在成像实践中应用的三维（3D）ECHO似乎是一种新兴的诊断技术，它克服了2D ECHO的一些局限性，同时整合了磁共振成像（MRI）提供的信息。然而，其在成像领域的作用仍存在争议。通过分析13例患者的17个黏液瘤，该研究发现了多样的解剖学特征谱。典型的CM形态占少数，大多数黏液瘤为无蒂型，且起源于意想不到的部位（右心室流出道和左心耳）。还注意到质地和大小的变化。比较成像结果，2D TEE在显示解剖特征，尤其是附着类型方面优于2D TT。3D TEE证实了2D TT的结果，并提供了更详细的评估，发现了2D TEE在4例中漏诊的蒂。两个小的复发性黏液瘤仅由3D TEE检测到，2D TEE或MRI未检测到。两名患者患有乳头状黏液瘤，一名患者发生栓塞。另一名患有实性黏液瘤的患者也发生了栓塞，手术中在心脏尖部发现了血栓。我们的研究表明，CM具有超出典型特征的广泛解剖学特征谱，这使得诊断具有挑战性。因此，多模态成像方法对于将CM与其他心脏肿块区分开来以及鉴别黏液瘤的组织学类型至关重要。这些发现强调了将3D ECHO与其他成像技术结合进行全面评估的重要性。
