■心脏冬眠是一种罕见的现象,文献中只有少数报道。它们难以用包括超声心动图在内的常规成像来表征,计算机断层扫描(CT),心脏磁共振(CMR),或正电子发射断层扫描(PET)。他们的明确诊断主要依赖于通过血管内或手术活检的组织病理学。以前的病例报告需要手术切除,然后进行组织病理学检查;然而,在一些围手术期风险增加的患者中,手术可能是不利的.
■我们介绍了一例57岁的女性,她被转诊到我们的心脏病学部门,在胸部CT上偶然发现了一个心房脂肪瘤肿块,用于评估肋骨骨折。她有6个月的不明原因晕厥,这归因于胸部CT显示的上腔静脉(SVC)按压。肿块在超声心动图上有良性特征,CT,和CMR,但在PET上是葡萄糖狂热的,这表明可能是恶性肿瘤,如脂肪肉瘤。她的合并症和非常严重的气道疾病使她无法进行手术切除,所以相反,进行了血管内活检.组织病理学显示棕色脂肪在荧光原位杂交测试中对小鼠双分钟2扩增呈阴性;因此,被诊断为冬眠瘤,一种罕见的棕色脂肪良性肿瘤。鉴于良性诊断和严重慢性阻塞性肺疾病的手术风险,提出了多学科建议,支持保守管理,进行仔细的随访,如果症状进展,考虑SVC支架置入。
■心脏冬眠瘤的明确诊断是复杂的,并且由于胸部影像学上的矛盾发现,严重依赖于组织病理学。在多学科团队环境中仔细考虑管理对于取得成功的结果至关重要。
UNASSIGNED: A cardiac hibernoma is a rare phenomenon, with just a handful of reports in the literature. They are difficult to characterize with conventional imaging including echocardiography, computed tomography (CT), cardiac magnetic resonance (CMR), or positron emission tomography (PET). Their definitive diagnosis relies primarily on histopathology via either endovascular or surgical biopsy. Previous case reports have entailed surgical excision followed by histopathology; however, surgery may be unfavourable in some patients with increased perioperative risk.
UNASSIGNED: We present the case of a 57-year-old woman who was referred to our cardiology service with an interatrial lipomatous mass found incidentally on chest CT for assessment of rib fractures. She had 6 months of unexplained syncope, which was attributed to superior vena cava (SVC) compression demonstrated by chest CT. The mass had benign characteristics on echocardiography, CT, and CMR but was glucose-avid on PET, which indicated a possible malignancy such as liposarcoma. Her comorbid and very significant airways disease precluded her from surgical excision, so instead, endovascular biopsy was performed. Histopathology showed brown fat which was negative for mouse double minute 2 amplification on fluorescence in situ hybridisation testing; hence, a diagnosis was made of hibernoma, a rare benign tumour of brown fat. Given the benign diagnosis and her surgical risk with severe chronic obstructive pulmonary disease, a multidisciplinary recommendation was made favouring conservative management, with careful ongoing follow-up and the consideration of SVC stenting if symptoms progressed.
UNASSIGNED: The definitive diagnosis of a cardiac hibernoma is complex and relies heavily on histopathology due to the contradictory findings on chest imaging. Careful consideration of management within a multidisciplinary team setting is essential to achieve a successful outcome.