J Cardiovasc Ultrasound.  2011 Jun;19(2):91-94. 10.4250/jcu.2011.19.2.91.

Unusual Presentation Chronic Pulmonary Embolism due to Calcified Right Ventricular Mass

• Hyun YK
• Cho YH
• Lee B
• Park HB

• KMID: 1980358
• DOI: http://doi.org/10.4250/jcu.2011.19.2.91

Abstract

Cardiac calcified amorphous tumors (CATs) can arise in all four chambers of the heart. Cardiac CATs can cause diverse symptoms according to their locations, and mass or embolic effects. Pulmonary emboli arising from cardiac CATs have been reported, but the true incidence is unknown due to their rarity. Herein we report a rare case with diffuse CATs in the right ventricle which caused a calcific pulmonary embolism and right-sided heart failure. Echocardiography, chest non-contrast computed tomography, and cardiac magnetic resonance imaging helped us diagnose the CATs. We recommend the usefulness of a multimodality imaging approach to characterize intracardiac masses and their complications accurately.

Keyword

Cardiac tumor; Pulmonary embolism; Right-sided heart failure

MeSH Terms

Animals
Cats
Echocardiography
Heart
Heart Failure
Heart Neoplasms
Heart Ventricles
Incidence
Magnetic Resonance Imaging
Pulmonary Embolism
Thorax

Figure

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  Fig. 1 Transthoracic echocardiogram. Diffuse calcified mass affecting the tricuspid chordal apparatus and the free wall of the right ventricle (A), which caused significant tricuspid regurgitation (B). The systolic pulmonary artery pressure was about 65 mmHg considering a tricuspid jet velocity of 3.76 m/s (C) and dilated inferior vena cava of 2.78 cm (D). RA: right atrium, RV: right ventricle, LV: left ventricle, LA: left atrium.

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  Fig. 2 Chest computed tomogram non-contrast imaging. The black arrowheads indicate calcified right ventricular amorphous tumor (A and B), and the white arrowheads indicate multiple pulmonary calcified emboli obstructing multiple pulmonary segmental arteries bilaterally (C and D).

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  Fig. 3 Cardiac fluoroscopic imaging. The white arrowheads indicate an irregular-shaped calcified mass in the right ventricle which was changed its shape and size during to the cardiac cycle.

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  Fig. 4 Cardiac magnetic resonance imaging. The white arrows indicate the tubular linear calcified mass extending from just below the tricuspid valve annulus to the right ventricular outflow tract.

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