A ventricular thrombus mimicking a tumour

Abstract

Primary cardiac tumours are a rare occurrence in clinical practice. Mural or pedunculated thrombi are other infrequent findings. These are usually associated with underlying heart disease, present in the left atrium or occupying aneurysms in the ventricular wall, usually the apex. The case of a 33-year-old woman with a pedunculated cardiac mass not having these latter characteristics is reported. She had experienced dyspnoea and lower extremity oedema for 3 years on referral. Echocardiography revealed a mass emerging from the interventricular septum, and a myxoma was suspected. Heart surgery was performed and the findings were a thrombus and large extent of septal and apical mural fibrosis. An endoaneurysmorraphy was performed with exclusion of fibrotic walls from the ventricular cavity.

Figure 1

Short axis delayed enhanced MRI. White arrows: bright transmural region in anterolateral myocardial wall indicating fibrosis probably due to previous silent myocardial infarction. Black arrows: a cardiac mass protruding from the interventricular septum. Some contrast is visible in the interior of the mass.

Figure 2

Parasternal long axis view showing a cardiac mass protruding from the interventricular septum into the left ventricle outflow tract. Ao, aorta; LA, left atrium; LV, left ventricle; RV, right ventricle.

Figure 3

Intraoperative view through an incision in the aorta, showing the interventricular septum on the left, the apex and free wall on the right. The cardiac mass is attached to the septum. The myocardium is mainly fibrotic in the area of the ventricle that is shown.

Figure 4

Light microscopy demonstrating the thrombus with its core in organisation along with new layer deposition on its exterior. H&E stain, 40×.