Author + information
- Saad S. Ahmad,
- Francisco Lopez,
- Angel Lopez Candales,
- Erin E. Coway-Habes and
- Robert O’Donnell
When evaluating syncope in a young pregnant patient, the most likely causes include pulmonary embolism (PE) and cardiac arrhythmia. We present an unusual cause of syncope masquerading as PE.
A 26 year old female, 14 weeks pregnant, presented with dyspnea, chest discomfort and syncope. On examination, she was hypotensive and tachycardic. A contrasted computed tomography (CT) of the chest showed a large filling defect in the proximal PA trunk presumed to be PE. Upon transfer to a tertiary care center, a transthoracic echocardiography (TTE) demonstrated a dilated right ventricle (RV) and a mass in the proximal PA, inconsistent with thrombus, causing hemodynamically significant obstruction. Cardiac magnetic resonance (CMR) imaging was then performed.
CMR showed a well-circumscribed, heterogeneous cystic mass causing critical obstruction of the proximal PA. RV remodelling suggested slow growth of the cyst and chronic RV pressure overload. The patient underwent urgent surgical excision of the mass and pathology reported a proteinacious cyst, wall composition indicating valvular origin. An increased gradient across the mass due to pregnancy related hemodynamic changes and/or acute enlargement of the cyst (area of hemorrhage noted) explained her presentation.
CMR is the gold standard for assessment of cardiac masses and was essential in characterizing the cyst. In this case, an extremely rare proteinaceous cyst was correctly diagnosed and treated.
Poster Hall B1
Sunday, March 15, 2015, 3:45 p.m.-4:30 p.m.
Session Title: FIT Clinical Decision Making: Imaging and Valvular Heart Disease
Abstract Category: Non Invasive Imaging
Presentation Number: 1213-150
- 2015 American College of Cardiology Foundation