|Year : 2016 | Volume
| Issue : 2 | Page : 70-71
Right ventricular mass: A tumor or thrombus
Mohsen Mouhebati, Atoosheh Rohani
Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
|Date of Web Publication||6-Jun-2016|
Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad
Source of Support: None, Conflict of Interest: None
Cardiac mass is always challenging, specially in the right side of the heart that should raise suspicion of a malignancy. A 15-year-old poor growth and poor weight gain girl with dyspnea was examined in the emergency room. Transthoracic echocardiography revealed a large homogeneous mass in the RV apex which disappeared one week after intravenous heparin therapy. A trial of anticoagulation should be considered when the differential diagnosis is difficult and thrombus is a possibility.
Keywords: Right ventricular mass, transthoracic echocardiography, tumor
|How to cite this article:|
Mouhebati M, Rohani A. Right ventricular mass: A tumor or thrombus. Heart India 2016;4:70-1
| Introduction|| |
A case of right ventricular (RV) mass with final diagnosis of RV clot-diagnosed at first as a RV tumor by transthoracic echocardiography--is presented.
Metastatic tumors of the heart are more common than primary cardiac tumors. The specific signs and symptoms produced by RV tumors will be the result of elevated right-sided pressure or low cardiac output because of obstruction to RV outflow, and sometimes pulmonary embolism is the first presentation. Patients with RV tumors will present with dyspnea, peripheral edema, hepatomegaly, and ascites. On physical examination, systolic murmurs, diastolic rumbles, and tumor plop have all been noted. This report presents a case of a RV mass caused by clot which was diagnosed retrospectively by complete disappearance of tumor after 1 week treatment with intravenous heparin. The clinical and echocardiographic findings are highlighted, and a review of the literature is discussed.
| Case report|| |
A 15-year-old poor growth and poor weight gain girl with dyspnea was examined in the emergency room. She was a known case of cystic fibrosis  on medical follow-up, and recent chest computed tomography (CT) revealed a large bullae and bronchiectasis. On auscultation, a 2/6 systolic murmur was heard at the right lower sternal border. Transthoracic echocardiography revealed normal size and systolic function of both the left and right ventricles. Mild to moderate tricuspid regurgitation was present. Pulmonary artery pressure was estimated to be 50 mmHg. A large 45 mm × 13 mm homogeneous mass was noted in the RV apex [Figure 1] and [Video 1]; heparin therapy was initiated for the patient. The patient underwent cardiac magnetic resonance imaging (MRI) 1 week later, and cardiac MRI revealed no mass. In follow-up echocardiogram, the mass was completely disappeared and RV apical clot was the final diagnosis.
| Discussion|| |
Cardiac mass is always challenging, especially in the right side of the heart that should raise suspicion of a malignancy in the heart. Echocardiography remains the initial imaging modality for the majority of patients with cardiac mass, but in many clinical scenarios, a transthoracic echocardiogram is not sufficient. Because of unique scenario of each patient, an individualized approach is recommended. Right heart thrombi are rare and in most circumstances, they are the results of mobilization of venous thrombi to the heart. Extent and attachment of right-sided heart thrombi could be better differentiated with transesophageal echocardiography.  Compared to echocardiography, MRI and CT offer a similar sensitivity of about 90%, with a slightly better specificity.  MRI could diagnose myxomas, fibromas, thrombi, and fatty tissue. T1-weighted images provide soft tissue characterization and T2-weighted images demonstrate fluid components of tissues. Kirkpatrick et al. showed that contrast perfusion imaging echocardiography could differentiate malignant and vascular tumors from stromal tumors and thrombi.  Our case highlights three important points: first of all, use of multimodality imaging such as cardiac magnetic resonance prevents misdiagnosis which often leads to unnecessary cardiac surgery. Second, cardiac thrombi, which generally occur in patients with structural heart disease, may occur in the right heart and can lead to an unnecessary surgical resection. Third, a trial of anticoagulation should be considered when the differential diagnosis is difficult and thrombus is a possibility [Video 1].
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ionescu AA, Ionescu AA, Payne N, Obieta-Fresnedo I, Fraser AG, Shale DJ. Subclinical right ventricular dysfunction in cystic fibrosis. Am J Respir Crit Care Med 2001;163:1212-8.
Goldman JH, Foster E. Transesophageal echocardiography (TEE) evaluation of intracardiac and pericardial masses. Cardiol Clin 2000;18:849-60.
Hoffmann U, Globits S, Frank H. Cardiac and paracardiac masses. Current opinion on diagnostic evaluation by magnetic resonance imaging. Eur Heart J 1998;19:553-63.
Kirkpatrick JN, Wong T, Bednarz JE, Spencer KT, Sugeng L, Ward RP, et al.
Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. J Am Coll Cardiol 2004;43:1412-9.
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