Expanding cardiac pseudotumor

Abstract

Cardiac calcified amorphous tumor (CAT) is a rare pseudoneoplastic mass composed of calcium deposits in a background of amorphous degenerating fibrin. Although the pathogenesis of this entity is not well understood CAT is a clinically important pseudoneoplasm because it often raises high suspicion for malignancy. CLINICAL SUMMARYA 75-year-old woman presented with episodic presyncope associated with palpitations. She was diabetic and hypertensive with a history of rheumatic fever with associated valvular dysfunction. Physical examination revealed an irregular pulse rate of 82 beats/min and no signs of left heart failure. On auscultation, a soft diastolic murmur was heard.Biochemical investigation results were all within normal limits, including serum calcium, parathormone levels, and proteins C and S. Electrocardiography confirmed atrial fibrillation and showed periods of sinus rhythm and firstdegree heart block. In-hospital telemetry demonstrated episodes of complete heart block rate that required permanent pacemaker.Transthoracic and transesophageal echocardiography showed the presence of a large echogenic mass at the basal inferior wall and inferoposterior mitral annulus extending into both the interventricular and interatrial septae. The mass appeared encapsulated, intramyocardial, and extensive (5.4 3 4.2 cm). The posterior mitral valve leaflet was clearly compressed by the mass, causing mild mitral stenosis and mild mitral regurgitation. Left ventricular function was preserved. Transthoracic echocardiography, performed 3 years previously to investigate a diastolic murmur, revealed a 2.5 3 1.8-cm calcific mass behind the posterior mitral valve leaflet. The patient was lost to follow-up.Computed tomography (Figure 1) of the chest and cardiac magnetic resonance imaging confirmed the presence From the

Surgical Treatment of Cardiac Tumors: A Single Institutional Experience Over 12 Years

“…18 IPTs are predominantly composed of degenerating fibrin with central nodular calcium deposits, mild to moderate chronic inflammation, and degenerating blood elements and can even present as large mass. 19 RCC represents 3% to 4% of all cancers, with about 5% to 10% presenting as extension IVC with tumor thrombus. 20,21 Combined excision of renal mass and its extension into IVC and RA as done by us has also been described by others.…”

Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature

“…Further histologic examination revealed that CAT is a basically a conglomerate of several elements, including focal inflammation, chalky and nodular central calcium deposits, degenerating blood constituents and fibrin . While visible on echocardiography, it is nearly impossible to make a definitive diagnosis with imaging given the lack of any pathognomonic features . Figure reveals a typical echocardiographic appearance of CAT.…”

“…In some cases, it can be mistaken for a valvular vegetation, especially if associated with preexisting MAC . In certain cases, obstruction of valves and embolization may occur . Surgery is diagnostic and curative in nearly all cases …”

“…2 While visible on echocardiography, it is nearly impossible to make a definitive diagnosis with imaging given the lack of any pathognomonic features. 57 Figure 8 reveals a typical echocardiographic appearance of CAT. In some cases, it can be mistaken for a valvular vegetation, especially if associated with preexisting MAC.…”

“…58 In certain cases, obstruction of valves and embolization may occur. 57,59 Surgery is diagnostic and curative in nearly all cases. 57…”