What thought to be a cardiac tumor turns out to be a remnant of former surgery (original) (raw)
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Left atrial mass in a patient with previous coronary artery bypass grafting
Journal-Cardiovascular Surgery, 2013
The association of coronary artery disease and left atrial myxoma is a rare entity. A 64-year-old man with previous off-pump coronary artery bypass grafting 11 years ago was presented with a large mobile and pedunculated left atrial mass detected incidentally. The patient underwent re-operation including resection of the left atrial mass and coronary artery bypass grafting. The postoperative course was uneventful. The histopathological examination revealed myxoma. We here mention the possibility of coronary artery disease and left atrial myxoma.
Intrapericardial gossypiboma found 14 years after coronary artery bypass grafting
Journal of Cardiothoracic Surgery
Background: Foreign body left after surgery surrounded by a foreign body reaction otherwise known as gossypiboma, have been first described in 1884. Although it occurs rarely, it can lead to various complications which include adhesions, abscess formation and related complications. Intrathoracic gossypiboma is a rare but serious consequence of negligence, mainly during abdominal and cardiothoracic surgery that can lead to severe medical consequences. This paper aims to raise awareness among surgeons and nurses in the operating room to prevent such errors and future complications. Case presentation: A patient with a history of coronary arterial bypass grafting performed 14 years ago, presented with shortness of breath and dry cough. A chest X-ray revealed a large mass in the left hemithorax. The chest CT demonstrated the presence of a heterogeneous density mass of 11 cm and smooth edges in the middle mediastinum, next to the heart and partially intrapericardial. Because clinical and radiologic evidence revealed presence of a mass, we did proceed with CT guided FNA of the mass. The cytology findings confirmed an inflammatory lesion. Based on patient symptomatology and the evidence of a mass, allegedly compressing the cardiopulmonary structures in vicinity, we performed surgical exploration. An old and degraded piece of surgical swap was found and removed through an anterolateral left thoracotomy. The post-operative course was excellent. Conclusions: Forgetting surgical swaps during surgery is a medical fault. To avoid them, surgical units should design and implement a surgical inventory process to account for surgical instruments or surgical swaps. Failure to make a proper diagnosis of cases such as these can lead to further health complications in these patients. The iatrogenic foreign material seen as a mass in the radiologic films had not been previously noticed by other health professionals although the patient had undergone X-ray and cardiac ultrasound examinations in the 14 years following coronary bypass surgery. Once the causative agent was identified and removed the patient returned to normal activity.
International cancer conference journal, 2012
Objectives The aim of this study is to present two patients with cardiac tumors, which by their localization, size and histopathological lineage, can be considered very rare. Methods The clinical, echocardiographic, computed tomography and pathological findings obtained in two examples were analyzed. Results The first case was a 54-year-old female who had progressive dyspnea with small efforts and presyncope of 1 month of evolution, most likely related to obstructive tricuspid valve myxoma-generated process, which protruded into the right ventricle reaching the apex, as was demonstrated in bidimensional color Doppler and tridimensional echocardiography. The second case was a 66-year-old male with a 6-month history of fatigue, weakness and dyspnea with great effort. The echocardiogram showed an heterogeneous ovoid mass in the right ventricle, attached to the interventricular septum with tricuspid septal leaflet infiltration. The cardiac computed tomography (CT) corroborated the presence of tumor with calcification and fat components, suggestive of teratoma, because mature cartilage tissue is not always identifiable with CT and Hounsfield units of cartilages are variable. The calcium density on the CT image is considered to be bone or cartilage, but is not specific. The differential diagnosis with liposarcoma is described in discussion. Conclusion Two-dimensional echocardiography is the primary diagnostic imaging modality in the morphological evaluation of intracardiac masses, it is also useful in the following-up of the possible recurrences. This technique is non-invasive, low cost and provides real-time imaging with high spatial and temporal resolution. Three-dimensional echocardiography is a useful tool that provides additional information and better morphological characterization of intracardiac masses. Computed tomography can accurately identify the components of the tumor and it contributed to the proper diagnosis of teratoma. In both patients, the diagnosis was early and precise, with surgical curative resection of the tumors and good prognoses.
Thoracic textilomas: CT findings
Jornal Brasileiro de Pneumologia, 2014
Objective: The aim of this study was to analyze chest CT scans of patients with thoracic textiloma. Methods: This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. Results: The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). Conclusions: It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication.
CT features of intrathoracic gossypiboma (textiloma)
Diagnostic and Interventional Radiology, 2011
ossypiboma or textiloma is a non-absorbable surgical material with a cotton matrix around which a foreign body reaction occurs. Although this condition is generally reported after abdominal laparotomy, a gossypiboma can occur following any surgical procedure. However, it is a rare complication after thoracic surgery (1, 2). The aim of this report is to present chest radiography and computed tomography (CT) findings for three cases in which patients presented with gossypibomas after cardiothoracic surgery. Case reports Case 1 A 50-year-old female who had undergone coronary artery bypass grafting 15 days earlier was admitted to our hospital with fever and dyspnea. She received medical therapy for pneumonia, but her symptoms persisted. A contrast-enhanced chest CT examination revealed a 6x4x6-cm, hypodense mass with multiple air bubbles and a peripheral hyperdense rim on the left side of the anterior mediastinum, which was consistent with a gossypiboma (Fig. 1). The patient underwent a second operation, and a retained surgical gauze sponge was removed from the anterior mediastinum. Case 2 A 64-year-old male who had undergone a right bilobectomy for a right lower lobe endobronchial lesion 30 days earlier underwent an unenhanced chest CT examination to evaluate a mass that was recognized on his control chest radiograph. A 7.5x6.5x4.5-cm, well-defined mass lesion with areas of low and high density, air bubbles and a hyperdense rim was observed extending from the apex to the tracheobronchial angle on the right side of the mediastinum (Fig. 2). The patient underwent a second operation, and a surgical gauze sponge was removed. Case 3 A 49-year-old male was admitted to our hospital with complaints of coughing and chest pain. His medical history revealed a coronary artery bypass grafting five years earlier. Posteroanterior and left lateral chest radiographs showed a peripheral mass lesion with incomplete border sign in the left hemithorax (Fig. 3a). An unenhanced chest CT examination revealed a well-defined pleural mass lesion with an obtuse angle in the left lower hemithorax, accompanied by a small pleural effusion (Fig. 3b). There was a ground-glass opacity around the lesion at lung window settings (Fig. 3c). A thoracotomy was performed, and a retained surgical sponge with peripheral fibrotic tissue was removed from the pleural space of the left lower lobe.
An ambiguous presentation of cardiac calcified amorphous tumor in a 37-year-old male
Journal of Surgical Case Reports
Calcified amorphous tumors are extremely rare benign cardiac lesions that can emerge in any chamber, and have many clinical obscurities. We herein report a case of a mid-aged previously healthy male with a complaint of recurrent chest pain. Echocardiogram revealed the presence of right atrial mass that was confirmed by transesophageal echocardiography. The patient underwent total resection of the mass with attached atrial wall. Pathological studies confirmed the diagnosis of calcified amorphous tumor. Five-year follow-up was uneventful with total symptomatic relief. In conclusion, we recommend considering the diagnosis of calcified amorphous tumors in any patient with intracardiac mass.