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Primary right atrial angiosarcoma mimicking acute pericarditis, pulmonary embolism, and tricuspid stenosis.

A 29 year old white man presented to the emergency room with new onset pleuritic chest pain and shortness of breath. He was initially diagnosed as having viral pericarditis and was treated with non-steroidal anti-inflammatory drugs. A few weeks later he developed recurrent chest pain with cough and haemoptysis. Chest radiography, cardiac examination, transthoracic and transoesophageal echocardiography pointed to a mass that arose from the posterior wall of the right atrium, not attached to the interatrial septum, which protruded into the lumen of the right atrium causing intermittent obstruction of inflow across the tricuspid valve. Contrast computed tomography of the chest showed a right atrial mass extending to the anterior chest wall. The lung fields were studded with numerous pulmonary nodules suggestive of metastases. A fine needle aspiration of the pulmonary nodule revealed histopathology consistent with spindle cell sarcoma thought to originate in the right atrium. Immunohistochemical stains confirmed that this was an angiosarcoma. There was no evidence of extracardiac origin of the tumour. The patient was treated with chemotherapy and radiation. This case highlights the clinical presentation, rapid and aggressive course of cardiac angiosarcomas, and the diagnostic modalities available for accurate diagnosis.

Adult↗

Tricuspid stenosis secondary to metastatic melanoma.

Cardiac metastases from malignant melanoma are frequent, usually asymptomatic and occur terminally. When responsible for symptoms, close evaluation of the patient is imperative for correct diagnosis and subsequent therapy. Surgical intervention where indicated in combination with chemotherapy and judicious use of irradiation constitutes optimal therapy.

Adult↗

Pathology of tricuspid valve stenosis and pure tricuspid regurgitation--Part II.

This three-part article examines the histologic and morphologic basis for stenotic and purely regurgitant tricuspid valves. In Part I, conditions producing tricuspid valve stenosis were reviewed. In Part II, conditions producing pure tricuspid regurgitation are discussed. In contrast to the relatively few causes of tricuspid stenosis, the causes of pure (no element of stenosis) tricuspid regurgitation are multiple. Some of the conditions producing pure regurgitation include floppy tricuspid valves, infective endocarditis, papillary muscle dysfunction, rheumatic disease, and Ebstein's anomaly.

Carcinoid Heart Disease↗

Pathology of tricuspid valve stenosis and pure tricuspid regurgitation--Part I.

This three-part article examines the histologic and morphologic basis for stenotic and purely regurgitant tricuspid valves. In Part I, conditions producing tricuspid valve stenosis are reviewed. In over 90% of stenotic tricuspid valves, the etiology is rheumatic disease. In isolated tricuspid stenosis, the etiology is either carcinoid or congenital. Rare causes of tricuspid stenosis include active infective endocarditis, metabolic or enzymatic abnormalities (Fabry's, Whipple's disease), and giant blood cysts.

Carcinoid Heart Disease↗

Application of autoregressive and Fast Fourier Transform spectral analysis to tricuspid and mitral valve stenosis.

Tricuspid and mitral valve flow area was determined from an apical four-chamber view. Doppler signals were recorded from normal subjects and patients with tricuspid and mitral valve stenosis by using a pulsed Doppler unit. The location of sample volume was chosen at the ventricular side of the valve orifice and within the right ventricular tract. This was done with the aid of an integrated cardiac imaging facility. The analog signal at the output of the Doppler unit was sampled and digitized using an analog/digital interface board and transferred to a personal computer. The data were then analyzed using the Fast Fourier Transform (FTT) and autoregressive (AR) modeling methods of spectral analysis and all the sonograms were obtained. Statistical comparison between the FFT and AR methods was made. The results show that the AR method offers a superior performance over the FFT method as regards the assessment of tricuspid and mitral valve stenosis.

Adult↗

Pathology of tricuspid valve stenosis and pure tricuspid regurgitation--Part III.

This three-part article examines the histologic and morphologic basis for stenotic and purely regurgitant tricuspid valves. In Part III, morphometric analysis of tricuspid valve annular circumference, leaflet area, and the product of annular circumference and leaflet area are shown to be useful in establishing etiology for the purely regurgitant tricuspid valves and in assessing the anatomic basis of pure tricuspid regurgitation in the presence of mitral stenosis.

Blood Pressure↗