Unusual Coronary Sinus Tumor in a Pregnant Woman

Abstract

SummaryPrimary coronary sinus tumors are extremely rare. Herein, we present a case of a pregnant woman with a primary myxoma in the coronary sinus (CS), which was diagnosed by echocardiography and computed tomography. We reviewed the literature and found two other primary CS tumors. We summarized the gender, ages, symptoms, diagnostic methods, associated anomalies, treatments, histologic findings, and outcomes of the 3 cases. Dyspnea was a common symptom of all 3 patients. Diagnostic methods included echocardiography, computed tomography, magnetic resonance imaging, and coronary angiography. Associated anomalies included coronary artery fistulas, coronary sinus orifice atresia with persistent left superior vena cava, intra-cardiac invasion, and pericardial effusion. The 3 histologic types of primary CS tumor were haemangioma, lymphoma, and myxoma. The 3 patients received proper treatment and had good therapeutic outcomes. (Int Heart J 2017; 58: 633-636) Key words: Primary, Myxoma, Echocardiography, Computed tomography C ardiac tumors are an uncommon imaging diagnosis, and are comprised of primary cardiac and metastatic tumors. 1) Primary cardiac tumors are rare, with a reported prevalence of 0.001%-0.030% in an autopsy series, while metastatic tumors of the heart are reported to be 10-1000 times more common.2) Three-fourths of primary cardiac tumors are benign, and nearly one-half of benign heart tumors are cardiac myxomas (CMs). CMs can occur anywhere in the heart, but most commonly arise in the left atrium (60%-80%), followed by the right atrium (15%-28%), the right ventricle (8%), and the left ventricle (3%-4%).3,4) Herein, we present the case of a pregnant woman with a CM in the coronary sinus (CS). Case ReportA 32-year-old primigravida presented to the emergency room with sudden abdominal pain at 38-week gestation. She also had dyspnea without fever. On physical examination, her respiratory rate was 30/minute, pulse was 95/minute, blood pressure was 130/85 mmHg, and her temperature was 37.0°C. There were no murmurs on auscultation of the heart. The electrocardiogram showed a normal heart rhythm. Emergency echocardiographic ultrasound showed a dilated CS and pericardial effusion (PE) in the parasternal long axis view ( Figure 1A). The dilated CS was filled with low echo. The 4 chambers of the heart did not have any abnormalities. This mass measured 3.97 × 3.01 cm in the apical 4-chamber view ( Figure 1B). To rule out infective endocarditis, the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein level were determined, which were all normal. To rule out a thrombus in the CS, parameters were determined, which were normal, including the D-dimer level (1.23 ug/mL). Therefore, there was a high likelihood that this mass was a tumor. Six hours later, she delivered a male infant with a birth weight of 3550 g by spontaneous vaginal delivery. To confirm the tumor type, contrast-enhanced chest computed tomography (CT) was performed 1 day later. Before contrast agent injection, it was reve...

Dual Aneurysms of the Left Anterior Descending Coronary Artery Initially Detected by Echocardiography

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Outcome and Pathological Characteristics of Primary Malignant Cardiac Tumors

“…1,25) Multiple cardiovascular imaging techniques can be used to provide comprehensive morphological information on cardiac mass, among which echocardiography, usually as the first-line diagnostic test. 26,27) After that, more information is needed to help differentiate between benign and THE CHARACTERISTICS OF PRIMARY CARDIAC TUMORS malignant tumors; in this regard, CT and MRI have played increasingly important roles in evaluating cardiac neoplasms. CT is capable of detecting calcification and generally has more reliable image quality, while MR imaging has better soft-tissue contrast.…”