Ong Wei Sheng Jonathan, Keh Yann Shan, Lai Siang Hui, Chang Huan Ying, Amanullah Mohammed Rizwan
Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.
Department of Pathology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Eur Heart J Case Rep. 2024 Aug 21;8(9):ytae439. doi: 10.1093/ehjcr/ytae439. eCollection 2024 Sep.
Cardiac blood cysts are exceedingly rare cardiac tumours usually found on cardiac valves in infants. We report and discuss a rare unique case wherein a giant atrial septal cardiac blood cyst was found in an adult.
A 59-year-old Chinese lady with history of hypertension, hyperlipidemia and transient ischaemic attack presented with atypical chest pain. Her ECG suggested right ventricular strain. Echocardiography revealed a large right atrial intracardiac mass attached to the interatrial septum which prolapsed into the right ventricle during each cardiac cycle with associated dilatation of the right atrium and right ventricle. Computed tomography scans showed no evidence of malignancy or metastasis. Considering our patient's profile and the characteristics of the mass, it was opined to likely be a cardiac myxoma. After consultation with our cardiothoracic surgeons, she underwent surgical resection of the intracardiac mass. Histology revealed that the intracardiac mass was a cardiac blood cyst.
First described by Elsasser in 1844, cardiac blood cysts are extremely rare benign cardiac tumours very rarely seen in adults. Though benign, they have been associated with outflow tract obstruction, valvular regurgitation and embolization. Symptomatic patients do well with surgical resection, while long-term outcomes in asymptomatic patients followed up with serial echocardiograms are mixed. Due to its rarity, existing literature is limited to case reports and small case series, with a lack of guidelines on management till recently. Our case report serves to highlight this unique presentation of an exceedingly rare intracardiac tumour.
心脏血囊肿是极其罕见的心脏肿瘤，通常在婴儿的心脏瓣膜上发现。我们报告并讨论一例罕见的独特病例，一名成年人被发现患有巨大的房间隔心脏血囊肿。
一名59岁的中国女性，有高血压、高脂血症和短暂性脑缺血发作史，出现非典型胸痛。她的心电图提示右心室劳损。超声心动图显示一个附着于房间隔的巨大右房心内肿块，在每个心动周期中脱垂至右心室，伴有右心房和右心室扩张。计算机断层扫描未显示恶性或转移迹象。考虑到我们患者的情况和肿块的特征，认为可能是心脏黏液瘤。在与心胸外科医生会诊后，她接受了心内肿块的手术切除。组织学检查显示心内肿块为心脏血囊肿。
心脏血囊肿于1844年由埃尔萨瑟首次描述，是极其罕见的良性心脏肿瘤，在成年人中极为罕见。尽管是良性的，但它们与流出道梗阻、瓣膜反流和栓塞有关。有症状的患者手术切除后效果良好，而对无症状患者进行系列超声心动图随访的长期结果不一。由于其罕见性，现有文献仅限于病例报告和小病例系列，直到最近仍缺乏管理指南。我们的病例报告旨在突出这种极其罕见的心内肿瘤的独特表现。
