Transcatheter Biopsy of Primary Cardiac Tumors Guided by Echocardiographic and Fluoroscopic Imaging

Onco-cardiology is a recently introduced field, and cardiologists are increasingly involved in cases of malignant tumors.¹ We present a case in which transcatheter biopsy of primary cardiac tumors guided by echocardiographic and fluoroscopic imaging led to substantial therapeutic improvement.

A 74-year-old man with general fatigue had a large amount of pericardial effusion without a clear cytological diagnosis. ECG showed 2 : 1 atrioventricular (AV) block (Figure A1); transthoracic echocardiography showed an irregular hypoechoic mass (22×29 mm) in the right atrium (RA); computed tomography showed a continuous mass in the atria, part of which was located near the AV node (Figure A2). Part of the mass was mobile in the RA. For definitive diagnosis, catheter biopsy was performed under transthoracic and transesophageal echocardiographic (TEE) and fluoroscopic guidance (Figure B1–B3; Supplementary Movies 1,2). TEE guidance was preferred over intracardiac ultrasound to avoid tumor embolization in this case. A bioptome was placed through a steerable long sheath via the inferior vena cava, and 4 samples were obtained from the fixed part of the tumor.

Figure.

(A1) ECG and (A2) CT before treatment. (B1) TTE, (B2) TEE, and (B3) fluoroscopic imaging during biopsy. (B4) Histopathologic image. (C1) ECG and (C2) CT after chemotherapy. Yellow arrows and dots show the fixed parts of the tumor and red arrows show the mobile parts of the tumor. Pink arrowheads show the bioptome’s tip. AO, aorta; CT, computed tomography; IVC, inferior vena cava; PA, pulmonary artery; RA, right atrium; RV, right ventricle; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography; TV, tricuspid valve.

Histopathologically, the mass was diagnosed as diffuse large B-cell lymphoma (Figure B4), and chemotherapy was initiated. After 18 months, the AV block had disappeared (Figure C1), and the tumor had nearly disappeared (Figure C2). During a 3-year follow-up, the lymphoma did not recur.

Supplementary Files

Supplementary Movie 1. TTE.

Supplementary Movie 2. TEE.

Please find supplementary file(s);

https://doi.org/10.1253/circj.CJ-23-0819

Reference

• 1.   Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the international cardio-oncology society (IC-OS). Eur Heart J 2022; 43: 4229–4361.