Clinical Picture
Calcified amorphous tumour of right ventricle Atiq Rehman, Elbert E Heng, Faisal H Cheema
A 62-year-old woman came to our clinic with a 2 month history of severe exertional dyspnoea. Investigations showed chronic pulmonary embolism and atrial septal defect, along with a right ventricular 3 × 2 cm mobile mass arising from the apex as seen on the preoperative transoesophageal echocardiography (appendix). A subsequent MRI showed the mass to be completely intracavitary and not infiltrating into the wall (appendix). After standard median sternotomy and cardiopulmonary bypass, a right atriotomy was done. The tricuspid valve was retracted and a long elliptical mass arising from papillary muscles just at the apex was identified (figure). It was not infiltrating the wall, but
extended almost to the right ventricular outflow tract. The mass was excised in total along with its base, and then sent for further pathological examination. Histology confirmed a cardiac calcified amorphous tumour (CAT) (appendix). First classified as non-neoplasmic intracardiac masses in 1997, CATs can arise in all four chambers of the heart, and are characterised by nodular calcium deposits over a fibrinous matrix background. The pathogenesis of CATs remains uncertain, and excision is necessary for differential diagnosis against common cardiac myxomas. Excision of CATs serves both diagnostic and therapeutic purposes.
Lancet 2014; 383: 815 Published Online February 14, 2014 http://dx.doi.org/10.1016/ S0140-6736(13)60997-6 University of Maryland School of Medicine, Baltimore, MD, USA (F H Cheema MD); College of Physicians and Surgeons of Columbia University – New York Presbyterian Hospital, New York, NY, USA (A Rehman MD); Sarasota Memorial Hospital, Sarasota, FL, USA (A Rehman MD); and Brown University, Providence, RI, USA (E E Heng MD) Correspondence to: Dr Faisal H Cheema, University of Maryland School of Medicine, 110 S Paca Street, 7-N-106, Baltimore, MD 21201, USA [email protected]
See Online for appendix
Figure: A calcified amorphous tumour in the right ventricle of the heart as seen through the tricuspid valve
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Calcified amorphous tumour of right ventricle Atiq Rehman, Elbert E Heng, Faisal H Cheema
A 62-year-old woman came to our clinic with a 2 month history of severe exertional dyspnoea. Investigations showed chronic pulmonary embolism and atrial septal defect, along with a right ventricular 3 × 2 cm mobile mass arising from the apex as seen on the preoperative transoesophageal echocardiography (appendix). A subsequent MRI showed the mass to be completely intracavitary and not infiltrating into the wall (appendix). After standard median sternotomy and cardiopulmonary bypass, a right atriotomy was done. The tricuspid valve was retracted and a long elliptical mass arising from papillary muscles just at the apex was identified (figure). It was not infiltrating the wall, but
extended almost to the right ventricular outflow tract. The mass was excised in total along with its base, and then sent for further pathological examination. Histology confirmed a cardiac calcified amorphous tumour (CAT) (appendix). First classified as non-neoplasmic intracardiac masses in 1997, CATs can arise in all four chambers of the heart, and are characterised by nodular calcium deposits over a fibrinous matrix background. The pathogenesis of CATs remains uncertain, and excision is necessary for differential diagnosis against common cardiac myxomas. Excision of CATs serves both diagnostic and therapeutic purposes.
Lancet 2014; 383: 815 Published Online February 14, 2014 http://dx.doi.org/10.1016/ S0140-6736(13)60997-6 University of Maryland School of Medicine, Baltimore, MD, USA (F H Cheema MD); College of Physicians and Surgeons of Columbia University – New York Presbyterian Hospital, New York, NY, USA (A Rehman MD); Sarasota Memorial Hospital, Sarasota, FL, USA (A Rehman MD); and Brown University, Providence, RI, USA (E E Heng MD) Correspondence to: Dr Faisal H Cheema, University of Maryland School of Medicine, 110 S Paca Street, 7-N-106, Baltimore, MD 21201, USA [email protected]
See Online for appendix
Figure: A calcified amorphous tumour in the right ventricle of the heart as seen through the tricuspid valve
www.thelancet.com Vol 383 March 1, 2014
815
