We describe the case of a 74-year-old woman who had a left atrial mass that was accidentally found by preoperative transthoracic echocardiography. We performed transesophageal echocardiography (TEE) for evaluation of the left atrial mass. TEE revealed that the tumor, 24×18 mm in diameter, was attached to the left atrial wall near the superior vena cava and the aorta. The left atrial cavity was filled with spontaneous echo contrast. We suspected that the diagnosis of the left atrial mass was thrombus because the patient was in chronic atrial fibrillation; however, we could not rule out the possibility of a tumor such as a myxoma because the mass was partially attached to the atrial septum. Warfarin was started at a dose of 3 mg a day, with the international normalized ratio of prothrombin time being adjusted to a range of 1.6 to 2.0. We ultimately diagnosed the mass as a left atrial thrombus because the mass completely disappeared with continuation of anticoagulation therapy for 5 months without any embolic events. TEE is useful for the differential diagnosis of left atrial masses.

View full abstract

We encountered a 77-year-old Japanese woman with a pancreatic tumor revealed by computed tomography (CT) in the upper gastrointestinal fiber area. The tumor was enhanced slowly by CT, and shown to be a hypo-intense lesion with a clear border in T1- and T2-weighted magnetic resonance imaging. FDG-PET/CT findings showed that FDG uptake by the tumor was low (SUV max 2.6). Also, endoscopic ultrasonography (EUS) revealed a slightly low echoic tumor with a clear border and surrounded by a thin low echoic rim (1.0 mm), though part of the border area contained a hypoechoic rim that was rather thick (2.5 mm in width, 6.0 mm in length). A definitive diagnosis could not be made based on the imaging results. Fine-needle aspiration was performed, and we made a diagnosis of pancreatic neuroendocrine tumor (PNET). A distal pancreatectomy was performed. The resected tumor was measured to be 28 × 26 mm in diameter, and a fibrous capsule was found. Tumor cell invasion beyond the capsule was partially observed, and the capsule in this part was thick (2.5 mm in width, 5 mm in length). These findings of tumor invasion could be detected by EUS but not by the other modalities utilized. EUS and endoscopic ultrasonography fine-needle aspiration (EUS-FNA) are thought to be useful and essential for precise diagnosis of a pancreatic tumor.

View full abstract

We herein report a case with uterine corneal rupture that occurred at 28 weeks of gestation. The patient was a 30-year-old primigravida without any history of uterine surgery. She had undergone regular pregnancy check-ups from the first trimester, and a normally located gestational sac had been confirmed by ultrasound at 8 weeks of gestation. She was admitted to our hospital for uterine contractions and genital bleeding at 26 weeks of gestation. On admission, a soft mass was felt by palpation at the left lateral region of the abdomen. An ultrasound examination revealed that the mass protruded from the uterine corneal position and had folded placenta in the mass. Threatened uterine rupture was suspected. At 27 weeks’ gestation, a reticular low echo area (39×24 mm) at the margin of the placenta was visualized. Along with frequent uterine contractions and tenderness of the mass at 28 weeks’ gestation, the low echo area increased at the margin of the placenta. Prolonged deceleration was also observed. A diagnosis of uterine rupture and placental abruption was made, and an emergency cesarean section was performed. The blood loss during the operation was 1065 g. A 1173 g healthy neonate was born with an Apgar score (1/5 min) of 8/9. The bulging lesion at the left corneal position was observed, and the myometrium was noted to be thin and ruptured. Similar to the antenatal diagnosis, a uterine rupture from the corneal position of the placenta was diagnosed. Wedge resection of the ruptured uterus at the corneal position was performed using three-layered sutures. Uterine rupture may occur when the placenta is located abnormally, even in cases at low risk for uterine rupture without a past history or perinatal characteristics.

View full abstract