- Email: [email protected]
An undiagnosed LV cyst – Probably blood cyst
Journal of Indian College of Cardiology 6 (2016) 96–97
Contents lists available at ScienceDirect
Journal of Indian College of Cardiology journal homepage: www.elsevier.com/locate/jicc
Abstract
An undiagnosed LV cyst – Probably blood cyst K. Venkatesan *, M.S. Ravi, N. Swaminathan, S. Venkatesan, G. Ravishankar, S. Saravanababu Institute of Cardiology, Madras Medical College, Chennai 3, India
A blood cyst in the heart is a rare clinical state and it is necessary to differentiate this from primary cystic tumors such as hemangioma and myxoma. Previous descriptions have stated that a blood cyst is usually small, is found on the endocardium (especially the valvular endocardium) in newborn infants, and is thought to have no clinical significance. Reporting a LV cystic mass in a 19-year-old adult is a rare one and the peculiarity of spontaneous disappearance with out treatment appears to be more significant of reporting this case.
moving in the LV cavity. We also had a plan of doing cardiac MRI. Since there is suspicious of hydatid cyst we have done ultrasound abdomen, USG abdomen reports were normal. Since she has history of drowning with lower respiratory tract infection she was started on parenteral antibiotics. With in a weeks Pt become symptomless and repeat echocardiogram done. To our surprise the two LV cyst completely disappeared without any squeale. We are very much worried whether the cyst was ruptured and embolized so she was kept under observation for another week. After two week patient was free of symptoms and she was discharged with advised regular followup.
2. Case history
3. Discussion
19-Year of female admitted with complaints of difficulty in breathing of Class-II NYHA for the past one week duration. She had also history of cough with expectoration for that she was evaluated in tertiary care hospital. There she was diagnosed to have? LV clot and they referred to our institution for further management. Ten days back she gives history of near drowning at the Vellankanni sea shore. She was advised for CT-thorax investigation and the reports came as bilateral upper lobe, lower lobe consolidation with medial segment of middle lobe, most probably of infective etiology. She was admitted in our CCU all the investigation parameters done, HB – 9.4 g, total count – 14,500, blood sugar, urea and ECG with in normal limits. Since she was referred as a case LV clot detailed echocardiogram was done, with left ventricle showed two cystic mass which looked like a small piece of clothlike flag attached to the LV endocardium, one attached to LV free wall and another attached to LV septum. Since patient is of young age without any history of RHD/cardiomyopathy LV clot was ruled out. Moreover Pt has normal LV systolic function. The size of the cyst attached to LV free wall measured around 2.3 cm 1.9 cm with broad based neck. Another cyst attached to the LV septum measured around 1.3 cm 1.5 cm with pedunculated attachment, with was freely
We referred the literature to find the cause for the LV cyst. The differential diagnosis for the cystic mass in the left ventricle includes hydatid cyst, LV clot, cardiac hemangiomas and tumors, blood cyst, intracardiac varices and bronchogenic cyst. Since our LV cyst had thick membrane which looks similar that of LV myocardium with central lucency and spontaneous disappearance of the cyst with a week, blood cyst appears to be the most probable cause for the left ventricular cyst. To say blood cyst the capsule should not contain any tumourous cells microscopically, the fluid in the cyst should be a clear homogenous one and it should be lined by normal endothelium cells delimiting from the endocardium with basement membrane. Blood cysts of the heart are rare benign tumors, usually involving the cardiac valves. They had also been described on papillary muscles and very rarely in endocardial cavity. They regress spontaneously by the age of 6 months and are rare in adults. They are often asymptomatic. The embolization and valvular dysfunctions had also been reported. It has been proposed that the blood cysts should be monitored with serial echo studies and removed routinely to exclude malignancy, and to avoid the potential risk of embolism. Our case showed disappearance of the cystic mass with in one week blood cyst will not fit in to the
1. Introduction
* Corresponding author. http://dx.doi.org/10.1016/j.jicc.2016.11.043 1561-8811/
K. Venkatesan et al. / Journal of Indian College of Cardiology 6 (2016) 96–97
diagnosis hence we concluded the cyst actually is a pseudocystic and with out proper investigation and treatment it completely vanished from its area. It still remains unclear why such large LV cyst should appear and disappear completely. Since it is rare to happen this case been reported with out knowing the cause?
Conflicts of interest The authors have none to declare.
97
Contents lists available at ScienceDirect
Journal of Indian College of Cardiology journal homepage: www.elsevier.com/locate/jicc
Abstract
An undiagnosed LV cyst – Probably blood cyst K. Venkatesan *, M.S. Ravi, N. Swaminathan, S. Venkatesan, G. Ravishankar, S. Saravanababu Institute of Cardiology, Madras Medical College, Chennai 3, India
A blood cyst in the heart is a rare clinical state and it is necessary to differentiate this from primary cystic tumors such as hemangioma and myxoma. Previous descriptions have stated that a blood cyst is usually small, is found on the endocardium (especially the valvular endocardium) in newborn infants, and is thought to have no clinical significance. Reporting a LV cystic mass in a 19-year-old adult is a rare one and the peculiarity of spontaneous disappearance with out treatment appears to be more significant of reporting this case.
moving in the LV cavity. We also had a plan of doing cardiac MRI. Since there is suspicious of hydatid cyst we have done ultrasound abdomen, USG abdomen reports were normal. Since she has history of drowning with lower respiratory tract infection she was started on parenteral antibiotics. With in a weeks Pt become symptomless and repeat echocardiogram done. To our surprise the two LV cyst completely disappeared without any squeale. We are very much worried whether the cyst was ruptured and embolized so she was kept under observation for another week. After two week patient was free of symptoms and she was discharged with advised regular followup.
2. Case history
3. Discussion
19-Year of female admitted with complaints of difficulty in breathing of Class-II NYHA for the past one week duration. She had also history of cough with expectoration for that she was evaluated in tertiary care hospital. There she was diagnosed to have? LV clot and they referred to our institution for further management. Ten days back she gives history of near drowning at the Vellankanni sea shore. She was advised for CT-thorax investigation and the reports came as bilateral upper lobe, lower lobe consolidation with medial segment of middle lobe, most probably of infective etiology. She was admitted in our CCU all the investigation parameters done, HB – 9.4 g, total count – 14,500, blood sugar, urea and ECG with in normal limits. Since she was referred as a case LV clot detailed echocardiogram was done, with left ventricle showed two cystic mass which looked like a small piece of clothlike flag attached to the LV endocardium, one attached to LV free wall and another attached to LV septum. Since patient is of young age without any history of RHD/cardiomyopathy LV clot was ruled out. Moreover Pt has normal LV systolic function. The size of the cyst attached to LV free wall measured around 2.3 cm 1.9 cm with broad based neck. Another cyst attached to the LV septum measured around 1.3 cm 1.5 cm with pedunculated attachment, with was freely
We referred the literature to find the cause for the LV cyst. The differential diagnosis for the cystic mass in the left ventricle includes hydatid cyst, LV clot, cardiac hemangiomas and tumors, blood cyst, intracardiac varices and bronchogenic cyst. Since our LV cyst had thick membrane which looks similar that of LV myocardium with central lucency and spontaneous disappearance of the cyst with a week, blood cyst appears to be the most probable cause for the left ventricular cyst. To say blood cyst the capsule should not contain any tumourous cells microscopically, the fluid in the cyst should be a clear homogenous one and it should be lined by normal endothelium cells delimiting from the endocardium with basement membrane. Blood cysts of the heart are rare benign tumors, usually involving the cardiac valves. They had also been described on papillary muscles and very rarely in endocardial cavity. They regress spontaneously by the age of 6 months and are rare in adults. They are often asymptomatic. The embolization and valvular dysfunctions had also been reported. It has been proposed that the blood cysts should be monitored with serial echo studies and removed routinely to exclude malignancy, and to avoid the potential risk of embolism. Our case showed disappearance of the cystic mass with in one week blood cyst will not fit in to the
1. Introduction
* Corresponding author. http://dx.doi.org/10.1016/j.jicc.2016.11.043 1561-8811/
K. Venkatesan et al. / Journal of Indian College of Cardiology 6 (2016) 96–97
diagnosis hence we concluded the cyst actually is a pseudocystic and with out proper investigation and treatment it completely vanished from its area. It still remains unclear why such large LV cyst should appear and disappear completely. Since it is rare to happen this case been reported with out knowing the cause?
Conflicts of interest The authors have none to declare.
97