Tony Chen, MD, Sina Jame, MD, Yogendra Kanthi, MD
A 51-year-old African American male was admitted for initiation of bendamustine for the treatment of chronic lymphocytic leukemia (CLL). His had a complicated hospital course characterized by new onset and difficult to control atrial fibrillation with rapid ventricular rate, intracranial hemorrhage in the setting of thrombocytopenia and neutropenic fever with positive blood cultures. An echocardiogram was obtained. His prior transthoracic echocardiogram had demonstrated a dilated left atrium and left ventricle with an otherwise normal LV systolic function. The repeat transthoracic echocardiogram one month later revealed the presence of two wide-based, nonmobile masses, one of which was attached to the inferior and inferoseptal wall of the left ventricle, while the other was located in the right ventricular outflow tract below the pulmonic valve (Figure 1). Subsequent cardiac magnetic resonance imaging (CMR) identified an additional third mass at the right ventricular anterior wall. (Figure 2).
What is the most likely diagnosis?
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Ventricular thrombi
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Infective endocarditis/vegetations
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Endocardial metastasis
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Myxomas
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Sarcomas
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References
1. Hoen Bruno, and Duval, Xavier. “Infective Endocarditis.” N Engl J Med 2013; 368:1425-1433 April 11, 2013 DOI: 10.1056/NEJMcp1206782
2. Bruce, Charles J. "Cardiac tumours: diagnosis and management." Heart 97.2 (2011): 151-160.
3. Bussani, Rossana, et al. "Cardiac metastases." Journal of clinical pathology 60.1 (2007): 27-34.
4. Goldberg, Aaron D., Ron Blankstein, and Robert F. Padera. "Tumors metastatic to the heart." Circulation 128.16 (2013): 1790-1794.
5. Lacey, Brent W., and Andrew Lin. "Radiologic evaluation of right ventricular outflow tract myxomas." Texas Heart Institute Journal 40.1 (2013): 68.
6. Seethala, Srikanth. "Left ventricular myxoma: Missed vs metastatic." World journal of cardiology 5.10 (2013): 387.
Author Information
Tony Chen, MD is an internal medicine resident at the University of Michigan in Ann Arbor, MI.
Sina Jame, MD is a cardiology fellow at the University of Michigan in Ann Arbor, MI.
Yogendra Kanthi, MD is a cardiology attending at the University of Michigan in Ann Arbor, MI.