47-year-old female with an apical mass
Clinical introduction
A 47-year-old female with no medical history presented with a sudden collapse. Physical examination, chest X-ray and high-sensitivity cardiac troponin I were normal, however ECG demonstrated anterior T-wave inversion. CT pulmonary angiography was performed which ruled out pulmonary embolism but revealed a non-calcified, homogenous mass at the left ventricular (LV) apex. It was not clear whether this mass was intramyocardial or pericardial. Transthoracic echocardiography confirmed the apical mass but was unable to establish its aetiology. Subsequent cardiac MR (CMR) demonstrated a highly vascular intramyocardial mass on perfusion imaging (Figure 1A, online ), with striking, homogenous late gadolinium enhancement (Figure 1B) consistent with a diagnosis of cardiac fibroma.1 The patient underwent successful surgical excision of the mass (see online ) and made a good symptomatic recovery, quickly mobilising around the ward. On examination, the patient was afebrile but had a blood pressure of 90/40 mm Hg and raised venous pressure. Postoperative imaging with echocardiography (see online ) and CMR (Figure 1C, D and online ) revealed some unexpected findings. Study the provided images.
Question
What is the next most appropriate management step?
Antibiotic therapy for pericardial abscess
Anticoagulation for LV thrombus
Intravenous fluids with close clinical and imaging follow-up of the intramyocardial haemorrhage and pericardial haema...
Source: Heart - Category: Cardiology Authors: Andrews, J., Lang, C. C., Dweck, M. Tags: Open access, Image challenges Source Type: research
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