A galloping cardiac mass: An MRI perspective

Flores, Rui Files; Mané, Fernando Guilherme; Pereira, Vítor Hugo; Vieira, Catarina

doi:10.1016/j.repc.2023.05.009

Revista Portuguesa de Cardiologia

ISSN: 0870-2551

A Revista Portuguesa de Cardiologia, órgão oficial da Sociedade Portuguesa de Cardiologia, foi fundada em 1982 com o objetivo de informar e formar os cardiologistas portugueses através da publicação de artigos científicos na área da arritmologia, cirurgia cardíaca, cuidados intensivos, doença coronária, ecocardiografia, electrofisiologia, hipertensão arterial, insuficiência cardíaca, métodos de imagem entre outros. Trata-se duma revista mensal de elevada qualidade científica e gráfica, publicada em português e em inglês desde 1999 o que permitiu a sua larga projeção no estrangeiro. É distribuída a todos os sócios da Sociedade Portuguesa de Cardiologia, da Sociedade de Medicina Interna, da Sociedade de Portuguesa de Pneumologia e da Sociedade de Cirurgia Cardiotorácica, bem como a cardiologistas estrangeiros de renome internacional e a quase todas as sociedades congéneres do mundo. É referenciada desde 1987 na Medline e posteriormente no Índex Copernicius.

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A 71-year-old woman was hospitalized for an unexplained fever. A positron emission tomography using PET-18FDG showed increased and diffuse uptake in the pericardium. An MRI revealed a small circumferential pericardial effusion and slight pericardial thickening over the right lateral side of the heart (Video 1, CINE sequences). The patient was discharged after the fever resolved. Some months later, she started having symptoms of exertional dyspnea and a dry cough. A CT raised concerns about a pericardial mass and multiple adenopathies. Reassessment by MRI showed a cardiac mass (84 mm×48 mm) with irregular borders in the right atrioventricular sulcus extending throughout the free wall of the right atrium (Video 2, CINE sequences). It was isointense on T1 (Panel, Image 1) and T2 (Panel, Image 2), hyperintense on T2 STIR (Panel, Image 3), and did not saturate in the fat saturation sequences (Panel, Image 4). It perfused on the first contrast passage (Video 2, perfusion sequences), with hypointense foci on early enhancement sequences (Panel, Image 5) and with a heterogeneous appearance on late enhancement sequences (Panel, Image 6). Exuberant adenopathy conglomerates were observed (Panel, Images 7 and 8, asterisk). A biopsy of an axillary lymph node revealed diffuse large B-cell lymphoma and chemotherapy was started.

Panel.

Panel exhibiting the cardiac mass characteristics on cardiac magnetic resonance imaging sequences. Image 1: T1 sequence. Image 2: T2 sequence. Image 3: T2 STIR sequence. Image 4: Fat saturation sequences. Image 5: Early enhancement sequence. Image 6: Late enhancement sequences. Images 7 and 8: Exuberant adenopathy conglomerates highlighted with an asterisk.

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Conflicts of interest

The authors have no conflicts of interest to declare.

Appendix A

Supplementary data

The following are the supplementary data to this article:

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CINE sequences of the magnetic resonance imaging performed at the first hospital admission showing a discrete thickening of the pericardium over its right lateral border, as well as a small pericardial effusion.

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CINE sequences of the second MRI showing a large pericardial mass without a cleavage plane, with irregular contours, and with partial compression of the right heart chambers.