Cardiovascular Pathology
Monday, February 28, 2005 - 7:30 PM
Convention Center, Room 006 C,D
Moderator:
Jeffrey Saffitz Washington University School of Medicine St. Louis, MO
Click on each slide thumbnail image for an enlarged view
Case 1
Submitted by: Debra L. Kearney Texas Children's Hospital Houston, TX
Clinical Summary:
Prenatal ultrasound of a 19 weeks gestation female fetus revealed a mediastinal mass and pericardial
effusion. The mass was not evident by ultrasound at 14 weeks gestation. Fetal echocardiography
demonstrated a 1.8 x 1.4 cm in maximum dimension, predominantly solid, pericardial tumor attached to the right
side of the aortic root, compressing the right-sided cardiac chambers and displacing the entire heart
into the left hemithorax. The pregnancy was terminated.
Case 2
Submitted by: Renu Virmani Armed Forces Institute of Pathology Washington, DC
Clinical Summary:
The patient is a 33-year-old man employed as a roofer with a 20-pack-year history of tobacco use who
presented with chest pain. He was admitted to the hospital at which time an acute myocardial infarction
was ruled out. On physical exam a pericardial friction rub was noted and was subsequently found to have
pericarditis with effusion. He was given Indomethacin, which resulted in marked improvement, but the
chest pain returned. An echocardiogram showed a large left atrial mass with possible mitral valve
involvement. Past medical history was significant for left leg and arm arterial thrombsis, a year prior
to this admission.
The patient underwent surgical removal of the left atrial mass, which measured 5.5 cm in diameter,
gelatinous in appearance and was attached to the interatrial septum.
Case 3
Submitted by: Jagdish W. Butany University of Toronto Toronto, ON, Canada
Clinical Summary:
This 56 year old previously healthy caucasian male presented with severe congestive heart failure. He
had a two-month history of increasing shortness of breath on exertion. He was in florid pulmonary edema
and had to be intubated on admission. He needed large does of inotropes, and was ventilated on 100%
oxygen. A transesophageal echo (TEE) revealed a large tumor mass in the left atrium. A CT scan showed
no lesions in the lungs.
Case 4
Submitted by: Henry Tazelaar Mayo Clinic Rochester, MN
Clinical Summary:
An 80 year-old man with a history of prostate cancer presented with fatigue and dysuria. He was found
to have a urinary tract infection and was treated with antibiotics. One month later he developed chills,
sweats and cough. He also had been noticing some mild right-sided weakness. A work up revealed another
urinary tract infection and a large vegetation on the atrial side of the anterior leaflet of the mitral
valve, which in addition was moderate to severely regurgitant. Blood cultures grew out Streptococcus
agalactiae. He underwent valve replacement and at the time of surgery was diagnosed with mitral valve
prolapse and vegetations as described above. Two specimens were submitted to surgical pathology: a
myxomatous valve with a focus of subacute endocarditis and separate "yellow to white purulent appearing
"vegetation" measuring 2.5 x 2.0 x 0.2 cm. Sections are from this latter specimen.
