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      Incidental discovery of right ventricular lipoma in a young female associated with ventricular hyperexcitability: An imaging multimodality approach

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          Abstract

          BACKGROUND

          Cardiac lipomas are rare benign tumors commonly found in the right atrium or left ventricle. Patients are usually asymptomatic, and clinical presentation depends on location and adjacent structures impairment. Right ventricle lipomas are scarce in the literature. Moreover, the previous published cases were reported in over 18-year-old patients.

          CASE SUMMARY

          We report a giant right ventricle lipoma discovered incidentally in a 17-year-old female while performing preoperative work-up. The diagnosis was confirmed by histopathological examination, and a conservative approach was performed.

          CONCLUSION

          Multimodal cardiac imaging and histopathological examination are required for a definitive diagnosis. The therapeutic approach depends on clinical presentation.

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          Most cited references 15

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          Primary and secondary neoplasms of the heart.

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            Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT.

            In the diagnostic algorithm of cardiac tumors, the noninvasive determination of malignancy and metastatic spread is of major interest to stratify patients and to select and monitor therapies. In the diagnostic work-up, morphologic imaging modalities such as echocardiography or magnetic resonance tomography offer information on, for example, size, invasiveness, and vascularization. However, preoperative assessment of malignancy may be unsatisfactory. The aim of this study was to evaluate the diagnostic value of (18)F-FDG PET and the incremental diagnostic value of an optimized CT score in this clinical scenario. (18)F-FDG PET/CT scans (whole-body imaging with low-dose CT) of 24 consecutive patients with newly diagnosed cardiac tumors were analyzed (11 men, 13 women; mean age ± SD, 59 ± 13 y). The maximum standardized uptake values (SUV(max)) of the tumors were measured. Patients were divided into 2 groups: benign cardiac tumors (n = 7) and malignant cardiac tumors (n = 17) (cardiac primaries [n = 8] and metastases [n = 9]). SUV(max) was compared between the 2 groups. Results were compared with contrast-enhanced CT, using standardized criteria of malignancy. Histology served as ground truth. Mean SUV(max) was 2.8 ± 0.6 in benign cardiac tumors and significantly higher both in malignant primary and in secondary cardiac tumors (8.0 ± 2.1 and 10.8 ± 4.9, P < 0.01). Malignancy was determined with a sensitivity of 100% and specificity of 86% (accuracy, 96%), after a cutoff with high sensitivity (SUV(max) of 3.5) was chosen to avoid false-negatives. Morphologic imaging reached a sensitivity of 82% and a specificity of 86% (accuracy, 83%). Both false-positive and false-negative decisions in morphology could be corrected in all but 1 case using a metabolic threshold with an SUV(max) of 3.5. In addition, extracardiac tumor manifestations were detected in 4 patients by whole-body (18)F-FDG PET/CT. (18)F-FDG PET/CT can aid the noninvasive preoperative determination of malignancy and may be helpful in detecting metastases of malignant cardiac tumors.
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              Cardiac Masses on Cardiac CT: A Review

              Cardiac masses are rare entities that can be broadly categorized as either neoplastic or non-neoplastic. Neoplastic masses include benign and malignant tumors. In the heart, metastatic tumors are more common than primary malignant tumors. Whether incidentally found or diagnosed as a result of patients’ symptoms, cardiac masses can be identified and further characterized by a range of cardiovascular imaging options. While echocardiography remains the first-line imaging modality, cardiac computed tomography (cardiac CT) has become an increasingly utilized modality for the assessment of cardiac masses, especially when other imaging modalities are non-diagnostic or contraindicated. With high isotropic spatial and temporal resolution, fast acquisition times, and multiplanar image reconstruction capabilities, cardiac CT offers an alternative to cardiovascular magnetic resonance imaging in many patients. Additionally, cardiac masses may be incidentally discovered during cardiac CT for other reasons, requiring imagers to understand the unique features of a diverse range of cardiac masses. Herein, we define the characteristic imaging features of commonly encountered and selected cardiac masses and define the role of cardiac CT among noninvasive imaging options.
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                Author and article information

                Contributors
                Journal
                World J Cardiol
                WJC
                World Journal of Cardiology
                Baishideng Publishing Group Inc
                1949-8462
                26 May 2020
                26 May 2020
                : 12
                : 5
                : 220-227
                Affiliations
                Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia
                Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
                Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
                Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik 1103, Lebanon. dr.anthonymatta@ 123456hotmail.com
                Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
                Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
                Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
                Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
                Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
                Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
                Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France
                Author notes

                Author contributions: All authors have contributed equally to this manuscript.

                Corresponding author: Anthony Matta, MD, Doctor, Cardiovascular Department, Institute CARDIOMET, Rangueil University Hospital, Toulouse 31400, France. dr.anthonymatta@ 123456hotmail.com

                Article
                jWJC.v12.i5.pg220
                10.4330/wjc.v12.i5.220
                7284002
                ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

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