258 Acknowledgements
We wish to thank Drs D.B. Evans and P. Williams for referring the patient and Dr. N. Cary for the pathological examination.
References
1 Chakko S, Richards F III. Right-sided cardiac thrombi and pulmonary embolism. Am J Cardiol 1987;59:195-196. 2 London AR, Runge PJ, Balsam RF, Bishop MB, Bousvaros
G. Large right atria1 thrombi surrounding permanent transvenous pacemakers. Circulation 1969;40:661-664. 3 Pliam MB, McGough EC, Nixon W, Ruttenberg HD. Right atrial ball-valve thrombus: a complication of central venous alimentation in an infant. J. Thorac Cardiovasc Surg 1979;78:579-582. 4 Nishimura T, Misawa T, Park YD, Uehara T, Hayashida K, Hayashi M. Visualization of right atrial thrombus associated with constrictive pericarditis by indium-111 oxine platelet imaging. J Nucl Med 1987;28:1344-1347. 5 Katagiri M, Tanabe Y, Takahashi M, Kasuya S. Right atrial thrombosis: association with constrictive pericarditis. Ann Thorac Surg 1990;49:145-146.
International Journal of Cardiology, 37 (1992) 258-260 0 1992 Elsevier Scientific Publishers Ltd. All rights reserved 0167-5273/92/$05.00
CARD10 15563
Pericardial metastasis and effusion as the initial manifestation of malignant thymoma: identification by cross-sectional echocardiography Wing-Hing Chow, Tsun-Cheung
Chow and Shui-Wah Chiu
Department of Cardiology, Grantham Hospital, Hong Kong, Hong Kong
(Received 25 March 1992; accepted 25 June 1992)
A patient with malignant thymoma is described in whom the initial manifestation effusion which were identified by cross-sectional echocardiography.
was pericardial metastasis and
Key words: Thymoma; Pericardial effusion; Echocardiography
Introduction
Thymoma is the most common primary tumour of the anterior mediastinum [I]. Patients with malignant thymoma might develop the complications of pericar-
dial metastasis and effusion through local invasion. In this report, a patient with malignant thymoma is described in whom the initial manifestation was pericardial metastasis and effusion which were identified by cross-sectional echocardiography. Case Report
Correspondence
to: Dr. W.H. Chow, Dept.
of Cardiology, Grantham Hospital, 125 Wang Chuk Hang Road, Hong Kong,
Hong Kong.
A 76yr-old retired watchman with a l-month history of progressive substernal pain and exertional dysp-
259
graphic scan showed a tumour in the thymus gland extending inferiorly onto the heart. He refused further treatment and was observed medically. At follow-up 2 yr later, he had remained well.
Discussion
Fig. 1. Chest radiograph showing the presence of cardiomegaly and an opacity over the right upper lung field.
Thymoma, the most common tumour of the anterior mediastinum, is malignant in 30-50% of the cases [l]. The diagnosis of malignant thymoma is primarily based on gross appearance of the tumour and features of surrounding invasion [l]. Local invasion might occur into the pleura, pericardium and lung [2]. Although malignant thymoma is included in the differential diagnosis of pericardial effusions, few cases of thymoma presenting with pericardial effusion or tamponade have been reported [3,4] and echocardiographic identification of pericardial metastasis from invasive thymoma is extremely uncommon. The distinction between different types of pericardial metastasis based on cchocardiographic appearance alone is difficult. A definitive diagnosis, which is important for treatment, can only be made by histopathological studies. Treatment of malignant thymoma is radical extirpation followed by adjuvant or combination radiotherapy with or without chemotherapy [4,5]. As the initial diagnosis in our patient was carcinoma of the lung with pcricardial metastasis and effusion, radical extirpation of the tu-
noea was admitted to the hospital. Physical examination revealed jugular venous distension, pulses paradox and mild ankle oedema. Blood pressure measured 90/50 mmHg. The heart sounds were distant and the liver was enlarged. The chest X-ray showed a large globular heart and an opacity over the right upper lung field (Fig. 1). Cross-sectional echocardiography was performed. Massive pericardial effusion was present. In addition, a heterogeneous mass was seen within the pericardial cavity encroaching itself onto the lateral aspect of left ventricle (Fig. 2). Because of symptoms of cardiac tamponade, he was operated on without further investigations. The preoperative diagnosis was carcinoma of the lung with pericardial metastasis and effusion. A small lateral thoracotomy was performed. Massive blood-stained pericardial effusion was seen and the presence of the mass at the pericardial cavity confirmed. A pericardial drain was inserted and a biopsy of the mass taken. His symptoms were relieved immediately and he had an uneventful recovery. Histopathological studies of the biopsy revealed the diagnosis of thymoma. A thoracic computed tomo-
Fig. 2. Cross-sectional echocardiography in modified apical 4-chamber view shows the presence of pericardial effusion (PE) and the pericardial metastasis (arrow). LV = left ventricle.
260
mour was not accomplished. Later, radiotherapy or chemotherapy was not offered as he refused further treatment.
References 1 Large SR, Shneerson JM, Stovin PG, Wallwork J. Surgical pathology of the thymus: 20 years experience. Thorax 1986;41:51-54.
2 Cohen DJ, Ronnigen LD, Graeber GM et al. Management of patients with malignant thymoma. J Thorac Cardiovasc Surg 1984;87:301-307. 3 Venegas RJ, Sun NCJ. Cardiac tamponade as a presentation of malignant thymoma. Acta Cytol 1988:32:257-262. 4 Rodriguez LI, Casal IL, Carballo C, Lado Lado F. Pleuopericardial effusion as the initial manifestation of malignant thymoma. Med Clin (Bare) 1985;84:377-378. 5 Eddie HU, Levine J. Chemotherapy of malignant thymoma. Cancer 1986;57:1101-1104.
International Journal of Cardiology, 37 (1992) 260-262 0 1992 Elsevier Scientific Publishers Ltd. All rights reserved 0167-5273/92/$05.00
CARD10 15564
Hypoplastic right ventricle with mild pulmonary stenosis in an adult K. Prasad, Mandeep Singh and S. Radhakrishnan Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
(Received 18 February 1992; accepted 26 June 19921
A rare cyanotic heart disease surviving to adulthood with minimal symptoms is presented. The final diagnosis was hypoplastic right ventricle with mild pulmonary stenosis, where the latter was not responsible for the right-to-left shunting across a large atria1 septal defect. The differences from cases reported in the literature are highlighted. Key words: Hypoplastic right ventricle; Pulmonary stenosis; Cyanotic heart disease
Introduction Hypoplastic right ventricle is a common terminology used to describe a small-sized right ventricle usually associated with obstruction or atresia of the right-sided valves with or without intact interventricular septum. There are, however, a group of patients who have this
condition as an isolated anomaly [l-4]. Because of restriction to right ventricular filling, right-to-left shunting across an atria1 septal defect occurs and the patient presents with cyanosis. We present here an adult with right ventricular hypoplasia in association with mild valvar pulmonary stenosis, where the latter was not severe enough to cause cyanosis.
Case Report Correspondence
to: Dr. S. Radhakrishnan,
Dept. of Cardiol ogy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, P.O. Box 375, Luckuow, Pin-226001, India.
This 27-yr-old male presented to us with a history of mild effort intolerance and cyanosis since young age. A
We wish to thank Drs D.B. Evans and P. Williams for referring the patient and Dr. N. Cary for the pathological examination.
References
1 Chakko S, Richards F III. Right-sided cardiac thrombi and pulmonary embolism. Am J Cardiol 1987;59:195-196. 2 London AR, Runge PJ, Balsam RF, Bishop MB, Bousvaros
G. Large right atria1 thrombi surrounding permanent transvenous pacemakers. Circulation 1969;40:661-664. 3 Pliam MB, McGough EC, Nixon W, Ruttenberg HD. Right atrial ball-valve thrombus: a complication of central venous alimentation in an infant. J. Thorac Cardiovasc Surg 1979;78:579-582. 4 Nishimura T, Misawa T, Park YD, Uehara T, Hayashida K, Hayashi M. Visualization of right atrial thrombus associated with constrictive pericarditis by indium-111 oxine platelet imaging. J Nucl Med 1987;28:1344-1347. 5 Katagiri M, Tanabe Y, Takahashi M, Kasuya S. Right atrial thrombosis: association with constrictive pericarditis. Ann Thorac Surg 1990;49:145-146.
International Journal of Cardiology, 37 (1992) 258-260 0 1992 Elsevier Scientific Publishers Ltd. All rights reserved 0167-5273/92/$05.00
CARD10 15563
Pericardial metastasis and effusion as the initial manifestation of malignant thymoma: identification by cross-sectional echocardiography Wing-Hing Chow, Tsun-Cheung
Chow and Shui-Wah Chiu
Department of Cardiology, Grantham Hospital, Hong Kong, Hong Kong
(Received 25 March 1992; accepted 25 June 1992)
A patient with malignant thymoma is described in whom the initial manifestation effusion which were identified by cross-sectional echocardiography.
was pericardial metastasis and
Key words: Thymoma; Pericardial effusion; Echocardiography
Introduction
Thymoma is the most common primary tumour of the anterior mediastinum [I]. Patients with malignant thymoma might develop the complications of pericar-
dial metastasis and effusion through local invasion. In this report, a patient with malignant thymoma is described in whom the initial manifestation was pericardial metastasis and effusion which were identified by cross-sectional echocardiography. Case Report
Correspondence
to: Dr. W.H. Chow, Dept.
of Cardiology, Grantham Hospital, 125 Wang Chuk Hang Road, Hong Kong,
Hong Kong.
A 76yr-old retired watchman with a l-month history of progressive substernal pain and exertional dysp-
259
graphic scan showed a tumour in the thymus gland extending inferiorly onto the heart. He refused further treatment and was observed medically. At follow-up 2 yr later, he had remained well.
Discussion
Fig. 1. Chest radiograph showing the presence of cardiomegaly and an opacity over the right upper lung field.
Thymoma, the most common tumour of the anterior mediastinum, is malignant in 30-50% of the cases [l]. The diagnosis of malignant thymoma is primarily based on gross appearance of the tumour and features of surrounding invasion [l]. Local invasion might occur into the pleura, pericardium and lung [2]. Although malignant thymoma is included in the differential diagnosis of pericardial effusions, few cases of thymoma presenting with pericardial effusion or tamponade have been reported [3,4] and echocardiographic identification of pericardial metastasis from invasive thymoma is extremely uncommon. The distinction between different types of pericardial metastasis based on cchocardiographic appearance alone is difficult. A definitive diagnosis, which is important for treatment, can only be made by histopathological studies. Treatment of malignant thymoma is radical extirpation followed by adjuvant or combination radiotherapy with or without chemotherapy [4,5]. As the initial diagnosis in our patient was carcinoma of the lung with pcricardial metastasis and effusion, radical extirpation of the tu-
noea was admitted to the hospital. Physical examination revealed jugular venous distension, pulses paradox and mild ankle oedema. Blood pressure measured 90/50 mmHg. The heart sounds were distant and the liver was enlarged. The chest X-ray showed a large globular heart and an opacity over the right upper lung field (Fig. 1). Cross-sectional echocardiography was performed. Massive pericardial effusion was present. In addition, a heterogeneous mass was seen within the pericardial cavity encroaching itself onto the lateral aspect of left ventricle (Fig. 2). Because of symptoms of cardiac tamponade, he was operated on without further investigations. The preoperative diagnosis was carcinoma of the lung with pericardial metastasis and effusion. A small lateral thoracotomy was performed. Massive blood-stained pericardial effusion was seen and the presence of the mass at the pericardial cavity confirmed. A pericardial drain was inserted and a biopsy of the mass taken. His symptoms were relieved immediately and he had an uneventful recovery. Histopathological studies of the biopsy revealed the diagnosis of thymoma. A thoracic computed tomo-
Fig. 2. Cross-sectional echocardiography in modified apical 4-chamber view shows the presence of pericardial effusion (PE) and the pericardial metastasis (arrow). LV = left ventricle.
260
mour was not accomplished. Later, radiotherapy or chemotherapy was not offered as he refused further treatment.
References 1 Large SR, Shneerson JM, Stovin PG, Wallwork J. Surgical pathology of the thymus: 20 years experience. Thorax 1986;41:51-54.
2 Cohen DJ, Ronnigen LD, Graeber GM et al. Management of patients with malignant thymoma. J Thorac Cardiovasc Surg 1984;87:301-307. 3 Venegas RJ, Sun NCJ. Cardiac tamponade as a presentation of malignant thymoma. Acta Cytol 1988:32:257-262. 4 Rodriguez LI, Casal IL, Carballo C, Lado Lado F. Pleuopericardial effusion as the initial manifestation of malignant thymoma. Med Clin (Bare) 1985;84:377-378. 5 Eddie HU, Levine J. Chemotherapy of malignant thymoma. Cancer 1986;57:1101-1104.
International Journal of Cardiology, 37 (1992) 260-262 0 1992 Elsevier Scientific Publishers Ltd. All rights reserved 0167-5273/92/$05.00
CARD10 15564
Hypoplastic right ventricle with mild pulmonary stenosis in an adult K. Prasad, Mandeep Singh and S. Radhakrishnan Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
(Received 18 February 1992; accepted 26 June 19921
A rare cyanotic heart disease surviving to adulthood with minimal symptoms is presented. The final diagnosis was hypoplastic right ventricle with mild pulmonary stenosis, where the latter was not responsible for the right-to-left shunting across a large atria1 septal defect. The differences from cases reported in the literature are highlighted. Key words: Hypoplastic right ventricle; Pulmonary stenosis; Cyanotic heart disease
Introduction Hypoplastic right ventricle is a common terminology used to describe a small-sized right ventricle usually associated with obstruction or atresia of the right-sided valves with or without intact interventricular septum. There are, however, a group of patients who have this
condition as an isolated anomaly [l-4]. Because of restriction to right ventricular filling, right-to-left shunting across an atria1 septal defect occurs and the patient presents with cyanosis. We present here an adult with right ventricular hypoplasia in association with mild valvar pulmonary stenosis, where the latter was not severe enough to cause cyanosis.
Case Report Correspondence
to: Dr. S. Radhakrishnan,
Dept. of Cardiol ogy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, P.O. Box 375, Luckuow, Pin-226001, India.
This 27-yr-old male presented to us with a history of mild effort intolerance and cyanosis since young age. A
