TY - JOUR
AB - An 81-year-old man with mitral valve repair in 2005, developed worsening mitral regurgitation and underwent trans-apical mitral valve replacement with a 26 mm Sapien tissue valve 12 years later. Two months following the procedure, he was admitted with a left pleural effusion, which was drained. A further 8 weeks later, he noted a gradually enlarging, painful soft tissue swelling over the left lateral chest. A contrast-enhanced computed tomography (CT) scan of the thorax demonstrated a soft tissue lesion consistent with a haematoma overlying the left ventricular (LV) apex and extending into the chest wall but no active contrast extravasation was demonstrated (Panel A). Subsequent cardiac magnetic resonance (MR) imaging showed the collection around the LV apex mostly contained around the pericardium but some amount extending into the intercostal space and chest wall (Panel B). Transthoracic echocardiography also demonstrated a suspected mass around the LV apex. None of the imaging modalities were able to confirm the precise source of the probable haematoma. A myocardial contrast echocardiogram (Panel C and D) was then performed, which clearly demonstrated isolated microbubbles escaping from the LV apex into the surrounding mass in the chest wall (see Supplementary data online, Video S1). The patient was managed conservatively and follow-up echocardiograms showed a reduction in bubble extravasation and resolving haematoma. This case highlights the novel use of real time myocardial contrast echocardiography in delineating the bleeding point and visualizing the continued extravasation of blood into a slowly growing haematoma from the LV cavity through the apex and into the surrounding thorax. Multimodality imaging of the LV apex and surrounding tissues. (Panel A) Contrast enhanced CT scan of the chest showing a haematoma overlying the LV apex (long arrow) and extending in to the chest wall (arrows). (Panel B) Cardiac MR image of the two-chamber view with gadolinium contrast showing a contrast filled mass around the LV apex and intercostal space (arrows). (Panel C) Low mechanical index myocardial contrast echocardiogram in a zoomed apical four-chamber view showing a soft tissue space overlying the LV apex (arrow) and (Panel D) which slowly fills with microbubbles (arrow). Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. View largeDownload slide View largeDownload slide Acknowledgements We would like to thank Cathy West for her assistance with acquisition of the echocardiographic images. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
TI - A slowly growing mass in the left chest wall: additive value of real time myocardial contrast echocardiography
JF - European Heart Journal – Cardiovascular Imaging
DO - 10.1093/ehjci/jey063
DA - 2018-04-10
UR - https://www.deepdyve.com/lp/oxford-university-press/a-slowly-growing-mass-in-the-left-chest-wall-additive-value-of-real-2nJgOJ02UR
SP - 1
EP - 956
VL - Advance Article
IS - 8
DP - DeepDyve
ER -