Category: General

Medicine (Baltimore). 2025 Jan 31;104(5):e41329. doi: 10.1097/MD.0000000000041329.

ABSTRACT

RATIONALE: Cardiac lipomas are known to cause functional disturbances and symptoms by compressing adjacent tissues or organs, leading to potential complications such as dyspnea, palpitations, and cardiac arrhythmias. We report a case of a 52-year-old female with a large, well-circumscribed lipoma in the right atrium. This rare condition required a comprehensive diagnostic approach and therapeutic strategy for effective management.

PATIENT CONCERNS: A 52-year-old female patient presented to the hospital with complaints of palpitations and fatigue lasting for 1 month, accompanied by the recent discovery of a cardiac mass via echocardiography over the past 2 days. In addition, she reported occasional episodes of a dry cough.

DIAGNOSES: Both echocardiography and cardiac computed tomography imaging revealed an isoechoic mass within the right atrium, characterized by a regular shape and close attachment to the right atrial wall, displaying noticeable mobility. Histopathological analysis following surgical intervention confirmed that the tumor was predominantly comprised of adipocytes.

INTERVENTIONS: The patient underwent successful resection of the right atrial lipoma, followed by reconstruction of right atrium using a bovine pericardial patch under extracorporeal circulation with a beating heart.

OUTCOMES: Postoperative recovery was complete, with resolution of symptoms including palpitations and fatigue. A follow-up echocardiogram on the 66th day postsurgery confirmed the absence of any residual tumor.

LESSONS: Patients with small lipoma often remain asymptomatic. However, large or rapidly progressing tumors may elicit symptoms such as chest pain, dyspnea, and palpitations. For asymptomatic patients with small tumors, regular observation and follow-up are typically advised to monitor tumor growth and the emergence of symptoms. Conversely, patients with large tumors or overt symptoms should be recommended for prompt surgical intervention. In this case, preoperative anatomical evaluation for the lipoma involves the right atrial free wall, which is crucial to prevent excessive resection, damage to the lateral bundle branch, and subsequent postoperative cardiac dysfunction or arrhythmia, as exemplified in this patient.

PMID:39889163 | PMC:PMC11789880 | DOI:10.1097/MD.0000000000041329

Ann Vasc Surg. 2024 Dec 13;112:22-31. doi: 10.1016/j.avsg.2024.11.095. Online ahead of print.

ABSTRACT

BACKGROUND: Echinococcosis is a parasitic disease caused by Echinococcus granulosus that most commonly affects the liver (70%) and lungs (20%). Despite rarely reported, arterial echinococcosis represents a severe and potentially life-threatening condition but management strategies and related outcomes have not been fully investigated.

METHODS: A comprehensive review of the international English literature was performed on PubMed, Scopus, and Web of Science from inception to May 30, 2024 to identify relevant articles about arterial echinococcosis. Data regarding epidemiology, pathogenesis, clinical presentation, diagnostic methods, and treatment were investigated.

RESULTS: A total of 143 articles were screened and 30 articles were included. Overall 32 cases were identified. About half of the patients were female (18, 56.2%) and the mean age was 40.6 years (range 12-60 years). Echinococcus cyst was more commonly detected on the aorta (27, 84.3%) in association or not with other cysts on the iliofemoral axis. Five cases (15.2%) affected only peripheral arteries. Most patients presented with chronic pain due to vascular obstruction or thromboembolism, while one patient was asymptomatic. In most cases (31, 96.8%) a total surgical excision was done in association with antiparasitic treatment using albendazole (17, 53.1%) or mebendazole (4, 12.5%). Arterial reconstruction was required in 19 cases (59.4%) and done with prosthetic substitutes or bovine pericardium. Only one case (3%) was treated with an endovascular approach. Four patients (12.5%) died in-hospital from hemorrhagic shock (3) or respiratory failure (1). During the follow-up period (mean 14 months, range 2-72 months) only one recurrence was reported.

CONCLUSIONS: Arterial echinococcosis is an extremely rare condition that may potentially be lethal. The current review showed favorable outcomes following complete surgical excision and antiparasitic drug that currently remain the only definitive treatment.

PMID:39675696 | DOI:10.1016/j.avsg.2024.11.095