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Cardiovascular Disease |

Endomyocardial Biopsy of a Right Atrial T-Cell Lymphoma Guided by Intracardiac Echocardiography (ICE)

Ahmed Al-Badri, MD; Sean Wilson; Chad Klinger; Carlos Ruiz
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Lenox Hill Medicine, New York, NY


Chest. 2014;145(3_MeetingAbstracts):78A. doi:10.1378/chest.1836618
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Abstract

SESSION TITLE: Cardiovascular Cases

SESSION TYPE: Case Reports

PRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PM

INTRODUCTION: Primary cardiac tumors are extremely rare with a prevalence of 0.02% in pooled autopsy studies. Lymphomas involving the heart have a prevalence between 1% to 2% of primary cardiac tumors. Diagnosis usually requires tissue biopsy either by open surgical tissue resection or image-guided biopsy. We report a case of a patient who found to have a primary cardiac T-cell lymphoma (PCTCL) of the right atrium (RA) diagnosed by biopsy guided by intracardiac echocardiography (ICE). (1, 2)

CASE PRESENTATION: A 66-year-old woman who presented with a 2 month history of progressive shortness of breath and orthopnea. Her ejection fraction decreased from 65% to 35% over a 4 year period. Coronary computed tomography angiography (CTA) revealed normal coronary arteries and a RA mass vs thrombus (Fig 1). A cardiac MRI with contrast was performed and the characteristic of the mass was suggestive of a lymphoma (Fig 2). Patient subsequently underwent percutaneous transcatheter biopsy of the RA mass using fluoroscopic and ICE guidance. Pathologic specimens demonstrated a T-cell lymphoma.

DISCUSSION: Patients with PCTCL typically remain asymptomatic until the mass leads to either obstruction of circulation, embolization, interference with valve function, decreased myocardial contractility or conduction disturbances. Histological diagnosis is made by biopsy and typically requires an open-chest procedure under general anesthesia. Transcatheter biopsy with transesophageal echocardiography guidance also requires general anesthesia. However, ICE imaging allows transcatheter biopsy of an intracardiac mass, especially of the right atrium. This can be made under direct visualization with conscious sedation, minimizing the risk for perforation. (3)

CONCLUSIONS: Intracardiac mass biopsy using ICE is an attractive modality which provides precise localization of cardiac structures under conscious sedation. This case illustrates successful use of imaging to minimize risk in the assessment of a cardiac mass.

Reference #1: Reynen K. Frequency of primary tumors of the heart. Am J Cardiol 1996;77:107-10.

Reference #2: Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of12,485 consecutive autopsies. Arch Pathol Lab Med 1993;117:1027-31.

Reference #3: Kuppahally S.,Litwin S. Endomyocardial Biopsy of Right Atrial Angiosarcoma Guided by Intracardiac Echocardiography. Cardiology Research and Practice Volume 2010, Article ID 681726

DISCLOSURE: The following authors have nothing to disclose: Ahmed Al-Badri, Sean Wilson, Chad Klinger, Carlos Ruiz

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