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Respiratory Failure in an Adolescent with Primary Cardiac Sarcoma.

Angeli D, Angeli SJ - Case Rep Cardiol (2015)

Bottom Line: An 18-year-old female presented to our hospital emergency department with progressive cough, dyspnea, and hemoptysis.An "intermediate" plasma brain natriuretic protein (BNP) of 216 pg/mL did not raise concerns about a heart failure diagnosis and may have delayed the correct diagnosis.Plasma BNP cutoff levels used in the adult population should not be extrapolated to adolescents, as levels, both normal and abnormal, are significantly lower in this group of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.

ABSTRACT
We report a case of progressive respiratory failure secondary to primary cardiac sarcoma masquerading as primary lung disease. An 18-year-old female presented to our hospital emergency department with progressive cough, dyspnea, and hemoptysis. She was treated for primary lung infection without improvement and had respiratory failure with endotracheal intubation by the third hospital day. An "intermediate" plasma brain natriuretic protein (BNP) of 216 pg/mL did not raise concerns about a heart failure diagnosis and may have delayed the correct diagnosis. Computed tomography of the chest with intravenous contrast was performed on the fifth hospital day and revealed a cardiac mass. A transthoracic echocardiogram confirmed a large left atrial mass that was obstructing mitral inflow. She was transferred to a tertiary center for emergency cardiac surgery. Primary cardiac tumors are a rare and treatable cause of heart failure in adolescent and young adult patients. Presentation can be confused with primary lung disease and must be suspected early. Plasma BNP cutoff levels used in the adult population should not be extrapolated to adolescents, as levels, both normal and abnormal, are significantly lower in this group of patients.

No MeSH data available.


Related in: MedlinePlus

Large, multilobular mass.
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fig5: Large, multilobular mass.

Mentions: The patient was referred for emergency cardiac surgery. At operation, she was found to have a large lobulated mass within the left atrium. It was attached to the septum but appeared to be growing along the free wall of the LA towards the mitral valve annulus. The valve was distorted due to the mass with thickening of the posterior leaflet. Excision of the mass and replacement of the mitral valve with a tissue prosthesis were performed. Separate lesions within the left atrium adherent to the endocardium were also sent for pathology study. Surgical pathology revealed high-grade cardiac sarcoma (malignant fibrous histiocytoma with foci of myxoid malignant fibrous histiocytoma and foci of necrosis. The tumor invades into the atrial myocardium and involves the lateral margins of the atrial tissue present in the specimen) (Figures 4 and 5).


Respiratory Failure in an Adolescent with Primary Cardiac Sarcoma.

Angeli D, Angeli SJ - Case Rep Cardiol (2015)

Large, multilobular mass.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556824&req=5

fig5: Large, multilobular mass.
Mentions: The patient was referred for emergency cardiac surgery. At operation, she was found to have a large lobulated mass within the left atrium. It was attached to the septum but appeared to be growing along the free wall of the LA towards the mitral valve annulus. The valve was distorted due to the mass with thickening of the posterior leaflet. Excision of the mass and replacement of the mitral valve with a tissue prosthesis were performed. Separate lesions within the left atrium adherent to the endocardium were also sent for pathology study. Surgical pathology revealed high-grade cardiac sarcoma (malignant fibrous histiocytoma with foci of myxoid malignant fibrous histiocytoma and foci of necrosis. The tumor invades into the atrial myocardium and involves the lateral margins of the atrial tissue present in the specimen) (Figures 4 and 5).

Bottom Line: An 18-year-old female presented to our hospital emergency department with progressive cough, dyspnea, and hemoptysis.An "intermediate" plasma brain natriuretic protein (BNP) of 216 pg/mL did not raise concerns about a heart failure diagnosis and may have delayed the correct diagnosis.Plasma BNP cutoff levels used in the adult population should not be extrapolated to adolescents, as levels, both normal and abnormal, are significantly lower in this group of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Montefiore Medical Center, Bronx, NY, USA.

ABSTRACT
We report a case of progressive respiratory failure secondary to primary cardiac sarcoma masquerading as primary lung disease. An 18-year-old female presented to our hospital emergency department with progressive cough, dyspnea, and hemoptysis. She was treated for primary lung infection without improvement and had respiratory failure with endotracheal intubation by the third hospital day. An "intermediate" plasma brain natriuretic protein (BNP) of 216 pg/mL did not raise concerns about a heart failure diagnosis and may have delayed the correct diagnosis. Computed tomography of the chest with intravenous contrast was performed on the fifth hospital day and revealed a cardiac mass. A transthoracic echocardiogram confirmed a large left atrial mass that was obstructing mitral inflow. She was transferred to a tertiary center for emergency cardiac surgery. Primary cardiac tumors are a rare and treatable cause of heart failure in adolescent and young adult patients. Presentation can be confused with primary lung disease and must be suspected early. Plasma BNP cutoff levels used in the adult population should not be extrapolated to adolescents, as levels, both normal and abnormal, are significantly lower in this group of patients.

No MeSH data available.


Related in: MedlinePlus