PDF(Pubmed)
Abstract：
BACKGROUND: The presence of a primary cardiac tumor in a pediatric patient is a rare echocardiographic finding.
METHODS: We report the case of an 11-year-old female patient with multiple peripheral embolisms, due to a gigantic left ventricular tumor, with a unique echocardiographic appearance. The patient was referred to the emergency department due to acute pain and loss of sensitivity in both of her legs. Past medical history was significant for acute lymphoblastic leukemia. Upon physical examination, suspicion of bilateral lower leg ischemia was raised. Doppler arterial ultrasound of both legs confirmed the suspicion mentioned above, as the right lower extremity suffered from partial arterial occlusion of the external iliac artery and total occlusion of the femoral arteries. Meanwhile, in the left lower extremity, the occlusion was localized in the proximal tibio-peroneal artery. Cardiac sonography revealed a massive, mobile, left ventricular intracavitary mass. Aside from its large dimensions (6.3 cm by 3 cm), its aspect was striking as well as it had very mobile and friable edges. Emergency bilateral endarterectomy and excision of the left ventricular tumor were performed alongside systemic anticoagulant therapy, with excellent results, as no tumoral residual masses could be seen in the left ventricle, and the arterial blood flow was restored completely in both lower extremities. The histopathological aspect of the excised masses was that of a myxoma. The patient recovered well after surgery and was discharged on postoperative day 14.
CONCLUSIONS: Despite only a handful of cases of cardiac myxomas being reported due to their rarity in the pediatric population, clinical presentation with peripheric embolism triggered a high index of suspicion of embolic mechanism in our patient and prompted a rapid assessment and successful management.
METHODS: We report the case of an 11-year-old female patient with multiple peripheral embolisms, due to a gigantic left ventricular tumor, with a unique echocardiographic appearance. The patient was referred to the emergency department due to acute pain and loss of sensitivity in both of her legs. Past medical history was significant for acute lymphoblastic leukemia. Upon physical examination, suspicion of bilateral lower leg ischemia was raised. Doppler arterial ultrasound of both legs confirmed the suspicion mentioned above, as the right lower extremity suffered from partial arterial occlusion of the external iliac artery and total occlusion of the femoral arteries. Meanwhile, in the left lower extremity, the occlusion was localized in the proximal tibio-peroneal artery. Cardiac sonography revealed a massive, mobile, left ventricular intracavitary mass. Aside from its large dimensions (6.3 cm by 3 cm), its aspect was striking as well as it had very mobile and friable edges. Emergency bilateral endarterectomy and excision of the left ventricular tumor were performed alongside systemic anticoagulant therapy, with excellent results, as no tumoral residual masses could be seen in the left ventricle, and the arterial blood flow was restored completely in both lower extremities. The histopathological aspect of the excised masses was that of a myxoma. The patient recovered well after surgery and was discharged on postoperative day 14.
CONCLUSIONS: Despite only a handful of cases of cardiac myxomas being reported due to their rarity in the pediatric population, clinical presentation with peripheric embolism triggered a high index of suspicion of embolic mechanism in our patient and prompted a rapid assessment and successful management.
摘要：
背景：儿科患者存在原发性心脏肿瘤是一种罕见的超声心动图发现。
方法：我们报告了一例11岁女性患者的多发性外周栓塞，由于巨大的左心室肿瘤,具有独特的超声心动图外观。由于急性疼痛和双腿失去敏感性，患者被转诊至急诊科。既往史对急性淋巴细胞白血病有重要意义。在体检时,怀疑双侧小腿缺血。两条腿的多普勒动脉超声证实了上述怀疑，右下肢髂外动脉部分闭塞，股动脉完全闭塞。同时,在左下肢，闭塞位于胫腓骨近端动脉.心脏超声检查显示，mobile,左心室腔内肿块。除了它的大尺寸（6.3厘米乘3厘米），它的外观是惊人的，以及它有非常移动和脆弱的边缘。急诊双侧动脉内膜切除术和左心室肿瘤切除术在全身抗凝治疗的同时进行。以优异的成绩,因为在左心室看不到肿瘤的残余肿块，下肢动脉血流完全恢复。切除肿块的组织病理学方面是粘液瘤。患者术后恢复良好，术后第14天出院。
结论：尽管由于在儿科人群中罕见，仅报道了少数心脏粘液瘤病例，外周栓塞的临床表现引发了我们患者对栓塞机制的高度怀疑,并促使患者进行快速评估和成功治疗.
方法：我们报告了一例11岁女性患者的多发性外周栓塞，由于巨大的左心室肿瘤,具有独特的超声心动图外观。由于急性疼痛和双腿失去敏感性，患者被转诊至急诊科。既往史对急性淋巴细胞白血病有重要意义。在体检时,怀疑双侧小腿缺血。两条腿的多普勒动脉超声证实了上述怀疑，右下肢髂外动脉部分闭塞，股动脉完全闭塞。同时,在左下肢，闭塞位于胫腓骨近端动脉.心脏超声检查显示，mobile,左心室腔内肿块。除了它的大尺寸（6.3厘米乘3厘米），它的外观是惊人的，以及它有非常移动和脆弱的边缘。急诊双侧动脉内膜切除术和左心室肿瘤切除术在全身抗凝治疗的同时进行。以优异的成绩,因为在左心室看不到肿瘤的残余肿块，下肢动脉血流完全恢复。切除肿块的组织病理学方面是粘液瘤。患者术后恢复良好，术后第14天出院。
结论：尽管由于在儿科人群中罕见，仅报道了少数心脏粘液瘤病例，外周栓塞的临床表现引发了我们患者对栓塞机制的高度怀疑,并促使患者进行快速评估和成功治疗.
