Papillary Fibroelastoma of the Tricuspid Valve Seen on Magnetic Resonance Imaging
2008; Lippincott Williams & Wilkins; Volume: 117; Issue: 11 Linguagem: Inglês
10.1161/circulationaha.107.729731
ISSN1524-4539
AutoresSebastian Kelle, Amedeo Chiribiri, Rudolf Meyer, Eckart Fleck, Eike Nagel,
Tópico(s)Cardiovascular Effects of Exercise
ResumoHomeCirculationVol. 117, No. 11Papillary Fibroelastoma of the Tricuspid Valve Seen on Magnetic Resonance Imaging Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBPapillary Fibroelastoma of the Tricuspid Valve Seen on Magnetic Resonance Imaging Sebastian Kelle, MD, Amedeo Chiribiri, MD, Rudolf Meyer, MD, Eckart Fleck, MD and Eike Nagel, MD Sebastian KelleSebastian Kelle From the Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (S.K., R.M., E.F.); Department of Radiology, Johns Hopkins University, Baltimore, Md (S.K.); Department of Internal Medicine, Division of Cardiology, University of Turin, Turin, Italy (A.C.); and Division of Imaging Sciences, King's College London, London, UK (E.N.). , Amedeo ChiribiriAmedeo Chiribiri From the Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (S.K., R.M., E.F.); Department of Radiology, Johns Hopkins University, Baltimore, Md (S.K.); Department of Internal Medicine, Division of Cardiology, University of Turin, Turin, Italy (A.C.); and Division of Imaging Sciences, King's College London, London, UK (E.N.). , Rudolf MeyerRudolf Meyer From the Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (S.K., R.M., E.F.); Department of Radiology, Johns Hopkins University, Baltimore, Md (S.K.); Department of Internal Medicine, Division of Cardiology, University of Turin, Turin, Italy (A.C.); and Division of Imaging Sciences, King's College London, London, UK (E.N.). , Eckart FleckEckart Fleck From the Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (S.K., R.M., E.F.); Department of Radiology, Johns Hopkins University, Baltimore, Md (S.K.); Department of Internal Medicine, Division of Cardiology, University of Turin, Turin, Italy (A.C.); and Division of Imaging Sciences, King's College London, London, UK (E.N.). and Eike NagelEike Nagel From the Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (S.K., R.M., E.F.); Department of Radiology, Johns Hopkins University, Baltimore, Md (S.K.); Department of Internal Medicine, Division of Cardiology, University of Turin, Turin, Italy (A.C.); and Division of Imaging Sciences, King's College London, London, UK (E.N.). Originally published18 Mar 2008https://doi.org/10.1161/CIRCULATIONAHA.107.729731Circulation. 2008;117:e190–e191A 72-year–old female patient with atypical chest pain and atherosclerotic risk profile was referred for cardiac magnetic resonance imaging at 3.0 Tesla (Phillips Achieva, Phillips Medical Systems, Best, The Netherlands), sus pected of having coronary artery disease. A resting ECG showed no signs of ischemia or chronic myocardial infarction (Figure 1A). Routinely performed echocardiography revealed a small suspicious mass at the tricuspid valve (Figure 1B). Cardiac magnetic resonance cine imaging revealed normal left ventricular function but, at rest, hypokinesia of the lateral wall of the basal slice. As an additional finding, an 8×8-mm, highly mobile, spherical pedunculate mass attached to the posterior tricuspid valve leaflet was found (Figure 2). T1-weighted images revealed the mass to be homogeneous but with higher signal intensity compared with myocardium. On the basis of a fat-suppression sequence, no fatty content of the tumor was found. Delayed enhancement images of the tricuspid valve tumor after administration of Gd-DTPA demonstrated hyperintense signal caused by the fibroelastic tissue of the mass. In addition, a 50% to 75% subendocardial scar of the lateral wall at basal level could be demonstrated. This lesion was located in correspondence to a wall motion abnormality at rest and was highly suspicious of ischemia due to underlying coronary artery disease. Invasive coronary angiography revealed triple-vessel disease with high-grade stenosis (Figure 3A). Bypass surgery and removal of the valvular tumor were performed. Download figureDownload PowerPointFigure 1. Resting ECGs (A) demonstrate no signs of ischemia or chronic myocardial infarction. Four-chamber transthoracic echocardiography revealed a small suspicious mass at the tricuspid valve (white arrow).Download figureDownload PowerPointFigure 2. Four-chamber view showing a pedunculate tumoral mass, size 8×8 mm, attached to the posterior tricuspid valve leaflet (white arrow) in a steady-state free precession cine magnetic resonance image (A). T1-weighted, turbo spin-echo image (B) shows homogeneous high signal intensity of the mass. With a T1-weighted, fat-suppressed sequence (C), a significant amount of fatty content was ruled out, as seen by the high signal intensity of the tumor compared with the suppressed signal from fat (open arrow). T1-weighted inversion-recovery images after intravenous administration of Gd- DTPA (D) show enhancement of tumor caused by the fibroelastic tissue of the mass (white arrow). In addition, a subendocardial myocardial scar was found at the basal lateral wall of the left ventricle (arrow heads).Download figureDownload PowerPointFigure 3. X-ray coronary angiography revealed coronary artery disease in all coronary arteries. In accordance with the wall motion abnormalities at rest, the circumflex artery (A) demonstrated high-grade stenoses. After bypass surgery and tumor removal, histological examination in hematoxylin-and- eosin stain (B) and periodic acid–Schiff reaction (C) revealed multiple branching papillary fronds consisting of dense fibroelastic tissue surrounded by a layer of loose connective tissue with mucopolysaccharides and endothelial cells (magnification ×10, both). D, The tumor was histologically diagnosed as a papillary fibrolelastoma covered with CD31-positive endothelial cells (magnification ×20).The tumor was histologically diagnosed as a papillary fibroelastoma covered with CD31-positive endothelial cells (Figure 3B through 3D). Papillary fibroelastomas are benign avascular growths of the endocardium with a matrix consisting of mucopolysaccharides. Such a tumor is located in most cases on the aortic or mitral valve and only in approximately 10% of cases on the tricuspid valve.1This rare case of a papillary fibroelastoma of the tricuspid valve demonstrates that cardiac magnetic resonance imaging allows characterization of suspicious tumor masses and can provide valuable guidance for surgical procedures. In addition, the case shows the combined finding of subendocardially located myocardial scar tissue, which is highly suggestive of underlying coronary artery disease. Magnetic resonance examinations are useful for detecting myocardial viability. In additional findings of cardiac masses, the characteristics of necrosis of the tumor can be described in the same session.The online-only Data Supplement, which contains movies, is available with this article at http://circ.ahajournals.org/cgi/content/full/117/11/e190/DC1.DisclosuresNone.FootnotesCorrespondence to Sebastian Kelle, MD, German Heart Institute Berlin, Department of Internal Medicine/Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail [email protected]Reference1 Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ. Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J. 2003; 146: 404–410.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Gatti M, D'Angelo T, Muscogiuri G, Dell'aversana S, Andreis A, Carisio A, Darvizeh F, Tore D, Pontone G and Faletti R (2021) Cardiovascular magnetic resonance of cardiac tumors and masses, World Journal of Cardiology, 10.4330/wjc.v13.i11.628, 13:11, (628-649), Online publication date: 26-Nov-2021. Saeedan M, Wang T, Cremer P, Wahadat A, Budde R, Unai S, Pettersson G and Bolen M (2021) Role of Cardiac CT in Infective Endocarditis: Current Evidence, Opportunities, and Challenges, Radiology: Cardiothoracic Imaging, 10.1148/ryct.2021200378, 3:1, (e200378), Online publication date: 1-Feb-2021. Giusca S, Buss S, Lasitschka F, Karck M and Korosoglou G (2019) Syncope in a female patient. Echocardiography and cardiac computed tomography reveal an unexpected diagnosis, Clinical Case Reports, 10.1002/ccr3.2164, 7:6, (1167-1170), Online publication date: 1-Jun-2019. 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March 18, 2008Vol 117, Issue 11 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.729731PMID: 18347215 Originally publishedMarch 18, 2008 PDF download Advertisement SubjectsComputerized Tomography (CT)Heart FailureValvular Heart Disease
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