Another great cardiology report. We discussed a patient with presyncope and an RV mass that was resected and found to be a “calcified amorphous tumor” – a very rare benign tumor of the heart!
Take-home teaching point: for RV masses, think about thrombus, tumor (primary vs metastatic) and infection (associated with hardware like pacemaker lead)
Cardiac tumors (teaching courtesy of Don Grandis, one of the cardiology attendings)
- Benign (80% of cardiac tumors)
- Myxoma (LA>RA>RV)
- Lipoma (characteristic appearance on MRI)
- Fibroelastoma (on valves usually, more often in women)
- Sarcoma (poor prognosis, often don’t tolerate surgery well, angiosarcoma can also have characteristic MRI appearance)
- Men: lung > esophageal > lymphoma
- Women: lung > breast > pancreas
Misc teaching points
- Remember that the RV is very arrhythmogenic. If you have a PA line in (rare these days) and a patient has lots of arrhythmias, check a CXR to make sure the tip of your line has not migrated back into the RV. Safer to just withdraw the line and remove the offending agent to the RV. Similarly, an RV mass can be arrhythmogenic (like this patient)
- Our morning MKSAP question was about FSGS and increased prevalence in African Americans. Harry told us about an interesting paper in Nature from 5-6 years ago that explained why this is the case. There is an apolipoprotein allele that is associated with increased risk of developing FSGS. However, it turns out that this gene has a role in innate immunity and protects against African trypanosomiasis. So while the genetic selection has protected against this parasitic infection, it comes at the cost of increased kidney disease! Fascinating!