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J Thorac Cardiovasc Surg 2005;130:202-205
© 2005 The American Association for Thoracic Surgery

Clinical-Pathologic Conference

Clinical-pathologic conference in cardiac surgery: Malignant schwannoma of the heart

Departments of Cardiovascular Surgery, Cardiology, Radiology, and Pathology, University of Padua, Padua, Italy

Received for publication November 9, 2004; revisions received November 29, 2004; accepted for publication November 30, 2004.

^_* Address for reprints: Tomaso Bottio, MD, Institute of Cardiovascular Surgery, Via Giustiniani, 2, 35128 Padova, Italy (Email: tomaso.bottio@unipd.it).

The first 20% of the full text of this article appears below.

	Case Presentation

 
Dr Bottio
The patient was a 51-year-old man presenting to a local emergency department in January 2003 with sinus node tachycardia, chest pain, and dyspnea. Laboratory data and arterial blood gas analyses were within normal values. The electrocardiogram demonstrated tachycardia (105 beats/min), left ventricular hypertrophy, and Q-waves in the anterior leads that were hypertrophy related. He had a chest radiograph that demonstrated a mediastinal abnormality with pleuropericardial effusion. Cardiac physical examination was unremarkable, as was his medical history. The hematologic and biochemical values were within normal limits. Transthoracic echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) were performed. Perhaps we could ask Dr Montisci to comment on transthoracic echocardiography.

Dr Montisci
Two-dimensional echocardiography showed a mildly enlarged aortic root (38 mm). Doppler scanning showed normal cardiac valve apparatuses. The left atrial chamber was compressed by an intrapericardial mass, without signs of discontinuity from the myocardial wall. The left and right ventricular chambers were normal in size and function. The right atrium was encircled and compressed by the mass, and the superior and inferior venae cavae were dilated. Only the right superior pulmonary vena cava was detectable at echocardiography.

Dr Bottio
Dr Corbetti, would you describe CT and MRI?

Dr Corbetti
The CT scan revealed an extensive mass growing into the pericardium and left thorax. The MRI is remarkable for an intrapericardial mass, probably originating from the pericardium. It is mostly homogeneous, except for the presence of some small cystic areas, and it grows deeply in the pericardial cavity at the back of the heart. The major diameter of the mass is 18 cm. The heart is dislocated up and forward (Figure 1). The heart is totally encircled by the mass; the left and right atrial chambers are compressed, and the pulmonary veins are tightened (Figure 2). Apparently the . . . [Full Text of this Article]

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