Author + information
- Received September 28, 2018
- Revision received November 14, 2018
- Accepted November 20, 2018
- Published online June 17, 2019.
- Abdallah El Sabbagh, MDa,
- Gautam Reddy, MDa,
- Mohammed Al-Hijji, MDa,
- Melanie C. Bois, MDb and
- John F. Bresnahan, MDa,∗ ()
- aDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- bDivision of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. John F. Bresnahan, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Cardiac masses can be caused by various etiologies (1). Current practice relies on imaging to characterize masses without providing a definitive diagnosis, which is often made after surgical resection. In some cases, it would be prudent to have a definitive diagnosis before subjecting the patient to the risks of surgery. Transcatheter biopsies of cardiac masses have been reported, particularly in right-sided masses (2). We present a case of a 59-year-old patient who presented with bilateral common iliac artery occlusion. Emergency embolectomy and histological review revealed thrombotic material. Transthoracic echocardiogram (TTE) revealed a large mass filling the left atrium (LA) and distorting the fossa ovalis (Figure 1). Magnetic resonance imaging showed a 6.4 × 6.7-cm LA extending into the right-sided pulmonary veins with patchy hyperenhancement consistent with malignancy or myxoma (Figure 1). A decision was made to proceed with biopsy via transseptal route using the flexible side-cutting Quick-Core Biopsy Needle System (Cook Medical, Bloomington, Indiana) (Figure 2) before considering high-risk surgical resection, given the extent of the mass and patient comorbidities (chronic obstructive pulmonary disease). Bilateral femoral venous access was obtained. The 7-F introducer sheath was advanced to the right atrium and the tip oriented toward the interatrial septum in the direction of the LA mass. The biopsy needle plunger was retracted, and the needle was inserted into the sheath and passed across the interatrial septum and into the mass under intracardiac echocardiographic (Figures 3A and 3B, Online Video 1) and fluoroscopic guidance (Figure 3C, Online Video 2). The cutting cannula was then fired, and core biopsy of the mass was successful. Repeat TTE showed no pericardial effusion. Pathology revealed poorly differentiated squamous cell carcinoma (Figure 3) with no primary source on subsequent positron emission tomography scanning. A decision was made to proceed with adjuvant chemotherapy and radiation to lessen the burden of the mass and increase the likelihood of adequate surgical resection.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 28, 2018.
- Revision received November 14, 2018.
- Accepted November 20, 2018.
- 2019 American College of Cardiology Foundation
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