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Cardiovascular Pathology
Wednesday, March 11, 2009, 7:30 PM
Convention Center 306
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Surgical Pathology of the Heart and Blood Vessels
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Moderator:
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ALLEN P. BURKE
University of Maryland School of Medicine
Baltimore, MD
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Disclosure:
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In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose.
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Panelists:
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MARC HALUSHKA, Johns Hopkins Medical Institutions, Baltimore, MD
JOHN VEINOT, Ottawa Hospital, Ottawa, Ontario, Canada
WILLIAM D. EDWARDS, Mayo Clinic, Rochester, MN
E. RENE RODRIGUEZ, The Cleveland Clinic Foundation, Cleveland, OH
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Clinical histories are displayed below.
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Submitted by: William D. Edwards, Mayo Clinic, Rochester, MN
A 73-year-old man was referred to the Mayo Clinic for worsening chest pain an shortness of breath. He had a two-year history of exertional chest discomfort. For the past two weeks, exertional chest pain had become more frequent and intense than previously, and it now radiated to the left shoulder. During this time, he has also developed nocturnal chest pain.
Coronary arteriography was performed and showed severe three-vessel disease, with 100% occlusion of the proximal RCA, 99% stenosis of the proximal LAD, and 80% stenoses of the LAD-D1 and LCX-OM1. An echocardiographic examination revealed severe aortic stenosis, with an effective valve orifice area of 0.6 cm2, moderate mitral regurgitation, an ejection fraction of 34%, and moderate left ventricular and left atrial dilatation.
Clinical diagnoses included severe coronary artery disease, unstable angina pectoris, severe aortic stenosis, and moderate systolic dysfunction. He underwent coronary artery bypass graft surgery and aortic valve replacement with a bioprosthetic valve. Gross photographs and a radiogram of the excised valve are provided for determination of the cause of aortic stenosis.
Submitted by: Marc K. Halushka, Johns Hopkins Medical Institutions, Baltimore, MD
A 60-year-old white woman underwent a routine endomyocardial surveillance biopsy to monitor for cardiac transplant rejection. It had been 4 years since her cardiac transplantation for ischemic cardiomyopathy.
Case 2 - Slide 1
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Submitted by: John Veinot, Ottawa Hospital, Ottawa, Ontario, Canada
This middle age married male, 2 pack/ day smoker, had a recent diagnosis of systemic arterial hypertension. He presented with a flu like illness, fever, pleuritic chest pain and was treated for pericarditis with an NSAID. He presented to ER with chest pain, dyspnea, fever and an elevated JVP - query tamponade. Echo demonstrated a pericardial effusion and impending tamponade. The provisional diagnosis was viral pericarditis with tamponade. Repeat ECHO demonstrated an extrinsic mass extending from the pericardial space through the epicardium to the endocardium into RV cavity. CT of the chest confirmed the right ventricle mass and also showed multiple pulmonary nodules.
The differential diagnoses entertained included TB, malignancy ? primary angiosarcoma or metastatic. TB testing was negative. Chemotherapy was planned so the oncologist wanted tissue to decide upon chemo type. A right ventricle endomyocardial biopsy was performed.
Case 3 - Slide 1
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Submitted by: E. Rene Rodriguez, Cleveland Clinic, Cleveland, Ohio
A 66-year-old female patient presented to an outside hospital with worsening abdominal pain, and found to have multiple intraabdominal aneurysms on angiography. She developed retroperitoneal hemorrhage that required bowel resection. A biopsy of the superior mesenteric artery was read as polyarteritis nodosa. She was treated with steroids. Postoperative course was complicated by intra-abdominal abscess and anastomotic leak requiring multiple surgeries. She also developed steroid-induced diabetes mellitus and glaucoma. She was transferred to Cleveland Clinic 3 months after the initial presentation.
On admission to CC, no new or prior symptoms suggestive of multiorgan system involvement were noted. Serologic studies were normal (ESR, CRP, C3, C4). Hepatitis B and C antibodies were negative. A review of the outside slides was requested.
Case 4 - Slide 1
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Case 4 - Slide 2
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Case 4 - Slide 3
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Case 4 - Slide 4
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Case 4 - Slide 5
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Submitted by: Allen P. Burke, University of Maryland Medical System, Baltimore, MD
A 45-year old man presented with shortness of breath. Echocardiography demonstrated a mass filling the left atrium, attached to the anterior leaflet of the mitral valve.
The mass was excised, with a portion of the mitral valve.
Case 5 - Slide 1
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