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- Received November 16, 2009
- Accepted November 21, 2009
- Published online April 20, 2010.
A 31-year-old woman with anxiety was seen by her primary care physician for progressive fatigue. Her electrocardiogram showed a left axis deviation, but was otherwise unremarkable. A transthoracic echocardiogram (A, Online Video 1) revealed a normal ejection fraction and wall motion and a large echo-bright nonmobile mass within the anterior-lateral wall roughly 2.5 × 2.5-cm (arrow)and protruding into the left ventricular cavity. Cardiac magnetic resonance imaging was performed to characterize the mass further and showed a high signal intensity area within the mass (arrow)on (B)a T2-weighted double inversion recovery imaging with fat saturation, suggestive of a highly vascular region. A coronary angiogram (C, Online Video 2) demonstrated aneurysmal dilation of the left circumflex artery with branch vessels supplying a highly vascular region (arrow)corresponding to the previously imaged intramyocardial mass. Because no other primary source was identified by further body computed tomographic imaging, the patient underwent a lateral thoracotomy and a surgical biopsy specimen was obtained. A Trichrome stain (D)revealed vascular proliferation with sections of hyalinized vessels (V) with fibrosis (F) and residual cardiac myocytes (arrows)most consistent with an arteriovenous malformation.
- Received November 16, 2009.
- Accepted November 21, 2009.
- American College of Cardiology Foundation