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Giant Endocardial Blood Cyst in the Right Atrium

2008; Lippincott Williams & Wilkins; Volume: 117; Issue: 25 Linguagem: Inglês

10.1161/circulationaha.107.734814

1524-4539

Tomasa Centella, José Luis Betrán Moya, María Muñoz, Eugenia M. Reguero,

Infective Endocarditis Diagnosis and Management

HomeCirculationVol. 117, No. 25Giant Endocardial Blood Cyst in the Right Atrium Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBGiant Endocardial Blood Cyst in the Right AtriumEchocardiographic and Magnetic Resonance Imaging Features Tomasa Centella, José Luis Moya, María Muñoz and Eugenia M. Reguero Tomasa CentellaTomasa Centella From the Ramón y Cajal Hospital, Madrid, Spain. , José Luis MoyaJosé Luis Moya From the Ramón y Cajal Hospital, Madrid, Spain. , María MuñozMaría Muñoz From the Ramón y Cajal Hospital, Madrid, Spain. and Eugenia M. RegueroEugenia M. Reguero From the Ramón y Cajal Hospital, Madrid, Spain. Originally published24 Jun 2008https://doi.org/10.1161/CIRCULATIONAHA.107.734814Circulation. 2008;117:3250–3251A 62-year-old patient, from the province of Cáceres (a region of endemic hydatidosis), with a history of elevated ferritin unrelated to the hemachromatosis gene, a hiatal hernia, mild esophagitis, and renal sinus cysts, was referred to the cardiology department for presyncopal episodes associated with headache. Cardiological examination revealed no data of interest. Both the ECG and thoracic x-ray were normal. Transthoracic echocardiography showed mild hypertrophy of the left ventricle with preserved systolic function and a 2.8-cm diameter round image with predominant hypogenicity inside, which was mobile and attached to the interatrial septum (Figure 1). Both serology and immunoglobulin E were negative for Echinococcus. Cardiac magnetic resonance imaging (MRI) was performed, which revealed a well-delimited round image attached to the interatrial septum in the right atrium, which exhibited a very low signal in the cine MRI sequence (steady-state free precession) and an isointense signal in the enhanced T1- and T2-weighted sequences. The lesion was heterogeneous, exhibiting a hypointense area in all sequences coincident with the area of calcification shown in the ultrasound scan (Figure 2). After administration of contrast media, no uptake was observed. Download figureDownload PowerPointFigure 1. Echocardiographic findings. A, Transthoracic echocardiography in subcostal projection presenting an image with a "cystic" appearance attached to the septum. It has an area of increased echogenicity inside, suggestive of calcification. B, The transesophageal study shows higher echogenicity in the content than in the atrial blood and delimits (C) the pedicle, connecting it to the foramen ovalis. D, The M-mode study shows higher density inside the mass than in circulating blood.Download figureDownload PowerPointFigure 2. Cardiac MRI images. A, Steady-state free precession sequence showing a rounded image with a very low signal in the right atrium. B, The enhanced T1 sequence shows an isointense homogenous signal in the lesion. C, In the enhanced T2 sequence, a slightly hyperintense signal may be observed.The tumor was excised by means of a cardiopulmonary bypass, and a nodule of some 3-cm diameter, with homogeneous characteristics and a purplish color suggestive of a benign growth with hematic content, was observed macroscopically. Histological examination confirmed the diagnosis of a simple blood cyst with a calcified area inside and no tumoral cells present (Figure 3). Download figureDownload PowerPointFigure 3. Surgical and histological images. A, Image of the tumor attached to the interatrial septum in the lower part of the foramen ovalis. B, Image of the interatrial septum after resection of the cyst. C, Hematic cyst excised with its implantation base. D, Histological image of the area near the endocardial implantation base.Blood cysts are usually small, are found mainly in newborns or young patients, and mainly affect valvular structures. Surgical resection is not necessary unless they impair the normal operation of the valves. They are rare in adults and in some cases may be mistaken for malignancies, or for hydatid cysts in endemic areas.Echocardiography indicated the cystic nature of the tumor which, because of the patient's geographical origins, suggested cardiac hydatidosis. However, cardiac MRI was important for its diagnosis. Hydatid cysts exhibit a different behavior under MRI, being hypointense in T1 sequences and hyperintense in T2 sequences. The low signal in the gradient-echo sequence and the isointense signal in T1 and T2 suggested chronic blood content. Because of the cyst's location, a myxoma could be suspected, but myxomas tend to be heterogeneous, and although some may exhibit a more homogeneous behavior, they always exhibit contrast uptake, being solid lesions. A chronic thrombus may have similar intensity in T1 and T2, but its round morphology, its well-defined margins, the presence of a tiny pedicle, and its cystic nature as revealed by MRI and echocardiography do not support this diagnosis.Although a cardiac blood cyst is a very rare finding, it can be diagnosed using cardiac MRI and it should be included in the differential table of masses inside heart cavities. A blood cyst may be suspected when a round homogeneous image is observed with signs of bleeding (iso- or hyperintense in T1 and iso- or hypointense in T2) with no uptake of IV contrast media, which indicates its hematic and cystic nature.DisclosuresNone.FootnotesCorrespondence to Tomasa Centella, PhD, Cardiac Surgery Department. C/Esteban Collantes 31, 2° B. 28017, Madrid, Spain. E-mail [email protected] eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Vahidshahi K, Tahouri T, Farahmandi F and Hekmat M (2023) Large right ventricular hydatid cyst in a child: a case report, The Egyptian Heart Journal, 10.1186/s43044-023-00386-x, 75:1 Gudauskas M, Sakaitė I, Macijauskienė L, Glaveckaitė S, Bacevičius J and Petrauskienė B (2022) Right atrial blood cyst of a patient with hypertrophic cardiomyopathy, Seminars in Cardiovascular Medicine, 10.2478/semcard-2022-0002, 28:1, (5-9), Online publication date: 1-Jan-2022., Online publication date: 1-Jan-2022. Jiang S, Wang X, Zhang Y, Yu W, Pei L and Ma Y (2021)(2021)(2021)(2021) Relato de Caso de Doença Cardíaca Valvular Complicada com um Cisto Sanguíneo no Átrio Direito. Revisão da Literatura, Arquivos Brasileiros de Cardiologia, 10.36660/abc.20210063, 117:6, (1202-1206), Online publication date: 22-Nov-2021., Online publication date: 22-Nov-2021., Online publication date: 1-Dec-2021., Online publication date: 1-Dec-2021. Beale R, Russo R, Beale C, Levin W, Atalay M, Fingleton J, Poppas A and Apostolidou E (2021) Mitral Valve Blood Cyst Diagnosed with the Use of Multimodality Imaging, CASE, 10.1016/j.case.2021.01.004, 5:3, (173-176), Online publication date: 1-Jun-2021. Imai A, Enomoto Y, Shigeta O and Suzuki Y (2020) Right atrial blood cyst in elderly patient: the timing of surgery, Asian Cardiovascular and Thoracic Annals, 10.1177/0218492320949406, 28:8, (500-503), Online publication date: 1-Oct-2020. 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Angelov A, Yotov Y, Kalchev K and Kunchev O (2013) Right atrium giant blood cyst in a young female with acute pericarditis, complicated with fatal cardiac tamponade, International Journal of Cardiology, 10.1016/j.ijcard.2012.08.047, 163:2, (e31-e32), Online publication date: 1-Feb-2013. Wood C, Sederberg J, Russ P and Seres T (2011) Cystic appearance of low-grade endometrial stromal sarcoma in the right atrium: case report, Cardiovascular Ultrasound, 10.1186/1476-7120-9-23, 9:1, Online publication date: 1-Dec-2011. June 24, 2008Vol 117, Issue 25 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.734814PMID: 18574062 Originally publishedJune 24, 2008 PDF download Advertisement SubjectsCardiovascular SurgeryCatheter Ablation and Implantable Cardioverter-DefibrillatorComputerized Tomography (CT)Echocardiography