Insuficiencia cardíaca como presentación de sarcoma cardíaco: caso clínico y revisión de la literatura / Cardiac sarcoma associated to heart failure: case report and review

RESUMEN: Los tumores cardíacos primarios malignos son infrecuentes en la práctica clínica. Suelen ser oligosintomáticos y de diagnóstico tardío lo que tiene como consecuencia una alta mortalidad. El caso clínico que se presenta a continuación es un ejemplo de esta patología, que debe ser especialmente considerada cuando la insuficiencia cardíaca no tiene una etiología clara. Se describen los hallazgos clínicos y de laboratorio, como también los resultados de estudios de imágenes y la histología. Se ilustra los hallazgos en la operación y la evolución clínica del paciente. Se incluye una revisión de la literatura.

ABSTRACT: Malignant primary cardiac tumors are infrequent in clinical practice. They are usually oligosymptomatic and a late diagnosis leads to a high mortality rate. The clinical case of a patient presenting with heart failure with unclear etiology is presented. Clinical and laboratory findings are described along with the results of imaging studies. Findings at the time of surgery and histopathological characteristics are illustrated. A review of the literature is included.

Rabdomiosarcoma alveolar con metástasis cardíaca en un paciente pediátrico / Alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient

El rabdomiosarcoma es el tumor maligno de partes blandas más frecuente en la edad pediátrica. Puede afectar cualquier localización anatómica. El subtipo histológico alveolar suele causar lesiones en las extremidades en niños de mayor edad. Los sitios metástasicos más frecuentes son el pulmón, la médula ósea, el hueso y los ganglios linfáticos. Describimos el caso de un paciente con rabdomiosarcoma alveolar (RA) con metástasis cardíaca, una presentación poco frecuente de la patología.

Rhabdomyosarcoma is the most common malignant soft tissue tumor in pediatric age. It can affect any anatomical location. Alveolar histological subtype usually presents lesions on the extremities in older children. The most common metastatic sites are the lung, bone marrow, bone and lymph node. We describe a case of alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient, a rare presentation of the pathology.

Importancia del rabdomioma cardiaco en población pediátrica. Experiencia de 39 años. Serie de casos / Importance of heart rabdomioma in pediatric population. A 39 year experience. Case series

Resumen Introducción: Los rabdomiomas son los tumores cardiacos benignos más prevalentes en la etapa fetal y durante la infancia. Objetivo: Nuestro objetivo es dar a conocer nuestra experiencia durante 39 años en pacientes pediátricos con rabdomioma en nuestra institución, así como enfatizar la importancia de su detección, estudio y control por la asociación que tiene con esclerosis tuberosa (ET). Material y métodos: Realizamos un estudio retrospectivo y descriptivo, de enero de 1980 a marzo del 2018. Veinticuatro cumplieron con nuestros criterios, recogimos información respecto a la clínica y estudios de gabinete, así como su evolución y el tratamiento dado. Se les llamó vía telefónica para conocer su evolución y estado actual. Resultados: Encontramos 51 pacientes con diagnóstico de tumor cardiaco, de los cuales 24 eran rabdomiomas. El diagnóstico se hizo prenatal en 8 pacientes, 5 al nacimiento y en 11 durante el primer año de vida. Las manifestaciones clínicas más frecuentes fueron la presencia de soplo, arritmias, cianosis, disnea y diaforesis. En 17 de ellos se hizo diagnóstico de ET. La mitad tuvo seguimiento por neurología, 10 por dermatología, 8 por oftalmología y 4 con genética. La mitad se dejó en vigilancia, a 7 se les dio tratamiento médico y 5 requirieron cirugía. En cuanto a la evolución, 17 pacientes se mantuvieron estables, 5 presentaron regresión espontánea y 2 fallecieron. Conclusiones: El rabdomioma es un tumor benigno poco frecuente, su evolución puede ser maligna y asociado a ET ensombrece el pronóstico.

Abstract Introduction: Rhabdomyomas are the most prevalent benign heart tumors in the fetal stage and during childhood. Objective: Our objective is to make known our experience over 39 years in pediatric patients with rhabdomyoma in our institution, as well as to emphasize the importance of its detection, study and control due to the association it has with tuberous sclerosis (TS). Material and methods: We conducted a retrospective, descriptive and cross-sectional study, from January 1980 to March 2018. Twenty-four met our criteria, we collected information regarding the clinic and cabinet studies, as well as their evolution and the treatment given. They were called by telephone to know their evolution and current status. Results: We found 51 patients with a diagnosis of cardiac tumor, of which 24 were rhabdomyomas. The diagnosis was made prenatal in 8 patients, 5 at birth and in 11 during the first year of life. The most frequent clinical manifestations were the presence of murmur, arrhythmias, cyanosis, dyspnea, and diaphoresis. In 17 of them a diagnosis of TS was made. Half had follow-up by neurology, 10 by dermatology, 8 by ophthalmology and 4 with genetics. Half were left under surveillance, 7 were given medical treatment and 5 required surgery. Regarding the clinical evolution 17 patients remained stable, 5 presented spontaneous regression and 2 died. Conclusions: Rhabdomyoma is a rare benign tumor, its evolution can be malignant and associated with TS, it darkens the prognosis.

Hipertrofia lipomatosa del septum interatrial: reporte de un caso / Lipomatous hypertrophy of the interatrial septum. A case report

Resumen La hipertrofia lipomatosa del septum interauricular (HLSI) es una entidad cardiaca rara y benigna, que se caracteriza por la acumulación de tejido adiposo dentro de algunos segmentos del septum interatrial. Generalmente, los pacientes son asintomáticos y estas lesiones se descubren de manera incidental mediante estudios de imagen realizados por otras razones, o en el contexto de una autopsia. Se han descrito casos de muerte súbita por alteración del ritmo cardiaco en estos pacientes. El diagnóstico diferencial de la HLSI incluye principalmente tumores cardiacos. Se expone el caso de un paciente de 61 años que, después de un estudio de resonancia magnética cardiaca, realizado por una alteración del ritmo cardiaco, presenta una masa en el septum auricular. El paciente es llevado a cirugía y el estudio histopatológico de la lesión confirma el diagnóstico. Se realiza una revisión de las características clínicas y patológicas de la HLSI.

Abstract Lipomatous Hypertrophy of the Interatrial Septum (LHIS) is a rare and benign cardiac entity that is characterized by the accumulation of adipose tissue within some segments of the interatrial septum. Patients are generally asymptomatic, and these lesions are discovered incidentally by imaging studies performed for other reasons, or in the context of an autopsy. In these patients, there have been described cases of sudden death due to disturbance of the heart rhythm. The differential diagnosis of LHIS mainly includes cardiac tumors. Here we present a case of a 61-year-old patient in whom, after a cardiac magnetic resonance study performed for an abnormal heart rhythm, it was documented a mass in the atrial septum. The patient was taken to surgery, and the histopathological study of the lesion confirmed the diagnosis. We conduct a review of the clinical and pathological characteristics of LHIS.

Aplicações da PET-TC 18F-FDG nos tumores cardíacos / PET-CT 18F-FDG applications in cardiac tumors

As neoplasias cardíacas são divididas em primárias e secundárias. As secundárias são 20 a 40 vezes mais comuns do que as primárias. Embora raras, as neoplasias cardíacas primárias podem ser benignas e malignas, sendo as benignas responsáveis por 75% dos casos. Os principais objetivos da imagem cardiovascular são definir a morfologia e etiologia do tumor, identificar potenciais complicações e auxiliar na definição de tratamento. Para o diagnóstico de neoplasias cardíacas, a tomografia por emissão de pósitrons acoplada à tomografia computadorizada (PET-TC) com a fluordesoxiglicose-F18 (18F-FDG) é uma técnica ainda pouco utilizada, principalmente nos tumores cardíacos primários. Entretanto, ela pode ajudar na diferenciação entre tumores malignos e benignos e, assim, evitar biópsias cardíacas e tratamentos invasivos desnecessários. Para esta revisão, realizamos pesquisa na base de dados PubMed, considerando as publicações sobre o tema nos últimos 10 anos. A PET-TC 18F-FDG é um exame útil para diferenciar massas cardíacas benignas das malignas, de acordo com o maior grau de metabolismo glicolítico encontrado nas neoplasias malignas. Além do mais, nos tumores malignos, a PET-TC 18F-FDG tem papel central no estadiamento da doença e pode ajudar na avaliação de resposta ao tratamento

Left atrial giant cell myocarditis presenting as a tumor: first-in-man case report

Abstract Giant cell myocarditis is a rare and highly lethal disorder with resultant cardiac insufficiency. It necessitates aggressive immune suppression therapy, although the results are often fatal. When it affects only the atria, the characteristics of the disease changes completely. In this case report, we present atypical presentation of atrial giant cell myocarditis with mass lesion, which completely resolved after successful surgical resection without immuno suppression therapy.

Patient in chronic hemodialysis with right atrial mass: thrombus, fungal endocarditis or atrial myxoma? / Paciente em hemodiálise crônica com massa em átrio direito: trombo, endocardite fúngica, ou mixoma atrial?

Abstract We present the case report of a 19-year-old patient with chronic kidney disease due to chronic glomerulonephritis, in hemodialysis (HD) by central catheter, with the incidental finding of a mass of 28x16 mm in right atrium (RA). The diagnosis of thrombus, infective endocarditis or myxoma were considered. Given the context of immunosuppression and difficult access vascular therapeutic practice has proved complex. Although Doppler echocardiography suggested thrombus in RA, nuclear magnetic resonance imaging (MRI) indicated for the diagnosis of myxoma in RA. In both conditions, the proposed surgical approach was limited by intense immunosuppression history and the risk of infectious complications. Throughout the treatment, the general state of K.M.F. remained satisfactory and revealed no signs or symptoms related to atrial dysfunction. The absence of fever and negative blood cultures excluded infective endocarditis. Prior echocardiogram report without masses in the RA decreased the chance of cardiac myxoma. The therapeutic response to anticoagulation confirmed the diagnosis of thrombosis. After 180 days of anticoagulation, there was significant reduction in mass. The patient developed asymptomatic. The diagnosis of mass in RA can be a challenge and only the evolution of the case was able to guide the appropriate conduit. While MRI has high sensitivity and specificity for the diagnosis of cardiac myxoma, the interpretation of images can be subjective. Controversial point is the removal of the catheter in such cases, which is subject discussed throughout the report.

Resumo Apresentamos o relato de caso de uma paciente de 19 anos com doença renal crônica devido à glomerulonefrite crônica e em hemodiálise (HD) por cateter central, com o achado incidental de uma massa de 28x16 mm em átrio direito (AD). Foram considerados os diagnósticos de trombo, endocardite infecciosa ou mixoma. Devido ao contexto de imunossupressão e dificuldade de acesso vascular, a condução terapêutica revelou-se complexa. Apesar de Ecodopplercardiograma sugerir trombo em AD, imagens de ressonância nuclear magnética (RNM) apontaram para o diagnóstico de mixoma em AD. Nas duas condições a proposta de abordagem cirúrgica esteve limitada pelo histórico de imunossupressão intensa e o risco de complicações infecciosas. Ao longo do tratamento, o estado geral de K.M.F. manteve-se satisfatório e não foram observados sinais ou sintomas relacionados a disfunção atrial. A ausência de febre e hemoculturas negativas excluíram endocardite infecciosa. O relato de ecocardiograma prévio sem massas em AD tornou menor a possibilidade de mixoma cardíaco. A resposta terapêutica à anticoagulação confirmou o diagnóstico de trombo. Após 180 dias de anticoagulação, houve redução significativa da massa. A paciente evoluiu assintomática. O diagnóstico de massa em AD pode ser um desafio e somente a evolução foi capaz de guiar a conduta apropriada. Apesar da RNM ter elevada sensibilidade e especificidade para o diagnóstico de mixoma cardíaco, a interpretação de imagens pode ser subjetiva. Ponto controverso é a retirada de cateter nesses casos, que é assunto discutido ao longo do relato.

Síncope secundario a mixoma gigante del anillo mitral: reporte de un caso / Large mitral annulus myxoma presenting with syncope: report of one case

We report a 23-year-old woman, with three recent exertional syncopes. Transthoracic (TTE) and transesophageal (TEE) echocardiography found a large heterogeneous mass (38 x 35 mm) arising from the posterior mitral annulus, protruding in systole through the left ventricular outflow tract (LVOT). Heart MRI confirmed the echocardiography findings, suggesting a cardiac myxoma. Cardiac surgery accomplished the complete resection of the lesion, confirming a mass arising from the posterior mitral annulus and preserving mitral anatomy and function. Pathology was positive for a myxoma. Uneventful evolution allowed the discharge of the patient at the fifth postoperative day. Control TTE discarded any complication.

Cardiac myxoma in pregnancy: a comprehensive review / Mixoma cardíaco na gravidez: revisão abrangente

AbstractObjective:Cardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses.Methods:A comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review.Results:Transthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49); while no surgical resection was performed in 4.1% (2/49) patients (P=0.000). More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47) vs. 12.8% (6/47), P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7%) cases. In the remaining 31 (60.8%) pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%), 14 (38.9%) and 17 (47.2%) patients, respectively. No patients died. In the delivery group, 20 (76.9%) neonates were event-free survivals, 4 (15.4%) were complicated and 2 (7.7%) died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery.Conclusion:The diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in even better maternal and feto-neonatal survivals.

ResumoObjetivo:Mixoma cardíaco durante a gravidez é raro e as características clínicas dessa entidade não foram suficientemente esclarecidas. Este artigo tem como objetivo descrever as opções de tratamento e os fatores de risco responsáveis pelo prognóstico materno e fetal-neonatal.Métodos:Foi realizada uma pesquisa abrangente na literatura sobre mixoma cardíaco durante a gravidez e 44 artigos com 51 pacientes foram incluídos na presente revisão.Resultados:Ecocardiografia transtorácica foi a ferramenta de diagnóstico mais comum para o diagnóstico de mixoma cardíaco durante a gravidez. Ressecção do mixoma cardíaco foi realizada em 95,9% (47/49); enquanto não foi realizada ressecção cirúrgica em 4,1% (2/49) dos pacientes (P=0,000). Mais pacientes tiveram ressecção isolada do mixoma cardíaco em comparação com aqueles com operação cardíaca concomitante ou adicional [87,2% (41/47) vs. 12,8% (6/47), P=0,000]. A interrupção voluntária da gravidez foi feita em 7 (13,7%) casos. Nas restantes 31 (60,8%) pacientes grávidas, a cesariana foi o modo de parto mais comum, representando 61,3% e parto vaginal contabilizou 19,4%. A cirurgia cardíaca foi realizada no primeiro, segundo e terceiro trimestre em 5 (13,9%), 14 (38,9%) e 17 (47,2%) pacientes, respectivamente. Nenhuma paciente morreu. No grupo de parto, 20 (76,9%) recém-nascidos sobreviveram livres de eventos, 4 (15,4%) tiveram complicações e 2 (7,7%) morreram. Os prognósticos neonatais não diferiram entre os modos de parto, opções de tratamento, tempo de cirurgia cardíaca e sequência de ressecção mixoma cardíaco em relação ao parto.Conclusão:O diagnóstico de mixoma cardíaco durante a gravidez é importante. Tratamento cirúrgico de mixoma cardíaco em pacientes grávidas trouxe resultados favoráveis para as mães e os neonatos no grupo de parto, o que pode ser atribuído à duração mais curta da operação e à natureza não emergencial da intervenção cirúrgica. O momento adequado da cirurgia cardíaca e melhoria das condições de circulação extracorpórea podem resultar em sobrevivência materna e do feto-neonato ainda melhor.

Stroke of a cardiac myxoma origin / Acidente vascular cerebral com origem em mixoma cardíaco

Abstract Objective: The clinical features of cardiac myxoma stroke have not been sufficiently described. Debates remain concerning the options and timing of treatment and the clinical outcomes are unknown. This article aims to highlight the pertinent aspects of this rare condition. Methods: Data source of the present study came from a comprehensive literature collection of cardiac myxoma stroke in PubMed, Google search engine and Highwire Press for the year range 2000-2014. Results: Young adults, female predominance, single cerebral vessel (mostly the middle cerebral artery), multiple territory involvements and solitary left atrial myxoma constituted the outstanding characteristics of this patient setting. The most common affected cerebral vessel (the middle cerebral artery) and areas (the basal ganglion, cerebellum and parietal and temporal regions) corresponded well to the common manifestations of this patient setting, such as conscious alteration, ataxia, hemiparesis and hemiplegia, aphasia and dysarthria. Initial computed tomography scan carried a higher false negative rate for the diagnosis of cerebral infarction than magnetic resonance imaging did. A delayed surgical resection of cardiac myxoma was associated with an increased risk of potential consequences in particular otherwise arterial embolism. The mortality rate of this patient population was 15.3%. Conclusion: Cardiac myxoma stroke is rare. Often does it affect young females. For an improved diagnostic accuracy, magnetic resonance imaging of the brain and echocardiography are imperative for young stroke patients in identifying the cerebral infarct and determining the stroke of a cardiac origin. Immediate thrombolytic therapy may completely resolve the cerebral stroke and improve the neurologic function of the patients. An early surgical resection of cardiac myxoma is recommended in patients with not large territory cerebral infarct. .

Resumo Objetivo: As características clínicas do acidente vascular cerebral causado por mixoma cardíaco não foram descritas suficientemente. Debates permanecem sobre as opções e o momento de tratamento e os resultados clínicos são desconhecidos. Este artigo tem como objetivo destacar os aspectos pertinentes desta condição rara. Métodos: Os dados do presente estudo foram levantados em uma revisão abrangente de literatura sobre acidente vascular cerebral causado por mixoma cardíaco no PubMed, no sistema de buscas do Google e no Highwire Press, abrangendo ao anos entre 2000 e 2014. Resultados: Adultos jovens, predominância do sexo feminino, vaso cerebral único (principalmente a artéria cerebral mediana), envolvimentos de territórios múltiplos e mixoma atrial esquerdo solitário são características marcantes destes pacientes. O vaso cerebral afetado mais comum (artéria cerebral média) e áreas (o gânglio basal, cerebelo e regiões parietais e temporais) corresponderam bem com as manifestações comuns destes pacientes, como alteração da consciência, ataxia, hemiparesia e hemiplegia, afasia e disartria. Tomografia computadorizada inicial mostrou taxa de falso negativo mais alta para o diagnóstico de acidente vascular cerebral do que a imagem por ressonância magnética. A ressecção cirúrgica tardia de mixoma cardíaco foi associada com risco aumentado de potenciais consequências, em particular, de outra forma de embolia arterial. A taxa de mortalidade dessa população de pacientes foi de 15,3%. Conclusão: Acidente vascular cerebral causado por mixoma cardíaco é raro. Frequentemente, afeta mulheres jovens. Para um diagnóstico mais preciso, exames de ressonância magnética e ecocardiográficos são imperativos para pacientes jovens com acidente vascular cerebral para determinar a localização do enfarte cerebral e se houve origem cardíaca. Terapia trombolítica imediata pode resolver completamente o acidente vascular cerebral e melhorar a função neurológica ...

Diagnostic dilemma: Intracardiac mass in a woman with Behçet's syndrome / Dilema diagnóstico: masa intracardiaca en una paciente con síndrome de Behçet

Intracardiac thrombosis is a rare manifestation of cardiac involvement in Behçet's disease, and it may be mistaken for a heart tumor. In this letter we present the case of a patient diagnosed with Behçet's disease who was incidentally found to have a mass in the right atrium suspicious of a cardiac tumor. Nevertheless, cardiac magnetic resonance showed a cardiac thrombus. Immunosuppressive therapy and anticoagulation were effective for thrombus resolution.

La trombosis intracardiaca es una manifestación muy rara del compromiso cardiaco en la enfermedad de Behçet, la cual puede confundirse con una masa tumoral. Se presenta el caso de una paciente con esta enfermedad a quien de manera incidental se le detectó una masa intraauricular derecha sugestiva de tumor intracardiaco. Sin embargo los hallazgos de la resonancia magnética cardiaca fueron los de un trombo intracavitario que se resolvió con tratamiento inmunosupresor y terapia anticoagulante.

Right Atrial Myxoma Complicated by Pulmonary Thromboembolism: A Case Report and Review of Literature.

Primary cardiac tumors are rare with myxoma being the most common benign cardiac tumor. They are usually sporadic, affecting left atrium and frequently occur in women. They are known to cause valvular obstruction, thromboembolism and arrhythmias. We present a case of right atrial myxoma complicated by pulmonary embolism. The atrial myxoma was diagnosed on autopsy.

Recaída extramedular de leucemia linfocítica aguda: reporte de un caso / Extramedullary relapse of acute linfoblastic leukemia: report of a case

El síndrome de vena cava superior (SVCS), considerado una emergencia, requiere tratamiento inmediato, por lo que el diagnóstico etiológico es esencial antes de decidir una conducta terapéutica. El manejo del SVCS consiste en el alivio de los síntomas y de la enfermedad subyacente. Los tratamientos tienen el objetivo de restituir el flujo sanguíneo. Se presenta un paciente de 5 años de edad, masculino, con antecedente de LLA tipo B. Su estado oncohematológico era remisión total y, en febrero de 2013, consultó por síndrome de dificultad respiratoria (SDR) de rápida evolución y edema facial, que progresó en 24 h. Se realizó angio TC de tórax y vasos de cuello, que evidenció tejido pseudonodular que comprime VCS. Se realiza biopsia endocavitaria de urgencia, que informa infiltración difusa Knfroproliferativa. Tratamiento quimioterápico, con buena evolución y egreso hospitalario. El SVCS es una emergencia oncológica que requiere diagnóstico oportuno y tratamiento inmediato a fin de mejorar los resultados.

The superior vena cava syndrome (SVCS) is considered an emergency and requires immediate treatment; therefore, the etiologic diagnosis is essential before deciding on its implementation. The management of SVCS consists on the relief of symptoms and treatment of the underlying disease, aiming to restore the blood flow. We present a 5 years old boy with a history of B-cell ALL. His oncologic state was that of complete remission. In February 2013 he consulted for respiratory distress syndrome (RDS) of rapid evolution, and facial edema which progressed within 24 hours. CT chest and neck angiography was performed, showing pseudo nodular tissue compressing the SVC. Emergency endocavitary biopsy reported diffuse lymphoproliferative infiltration Chemotherapy is administered, with good results and hospital discharge. The SVCS is an oncologic emergency that requires prompt diagnosis and immediate treatment in order to improve results.

Angiosarcoma cardíaco: una neoplasia infrecuente / Cardiac angiosarcoma: an infrequent neoplasia

Los tumores cardíacos son infrecuentes, siendo los más comunes los metastásicos. De los primarios, sólo el 25 por ciento son malignos, donde el angiosarcoma es el más frecuente. Este corresponde a un tumor de alto grado de malignidad, caracterizado por un rápido crecimiento, obstrucción de válvulas y metástasis principalmente pulmonares. Es más frecuente entre los 30 y 50años, especialmente en el género masculino, con una relación de2:1. Su clínica es de naturaleza cardiovascular inespecífica y su pronóstico es malo, con una supervivencia de entre nueve a doce meses a partir del diagnóstico. Presentación del caso: Paciente de género femenino, de 50 años de edad, con antecedentes de hipertensión arterial y artritis reumatoide. Consultó por disnea y deterioro de capacidad funcional. Ecocardiograma transtorácico mostró masa de seis centímetros de diámetro, que ocupa toda la aurícula derecha y que generaba obstrucción al flujo tricuspídeo, asociado a derrame pericárdico masivo con taponamiento cardíaco. Tomografía computada (TC) de cerebro, tórax, abdomen y pelvis descartan lesiones metastásicas. Se decidió conducta quirúrgica. Se resecó el tumor y el 70 por ciento de la pared libre de la aurícula y se instaló prótesis valvular biológica; con pericardio autólogo se reconstruyó la aurícula derecha. Evolucionó favorablemente, sin incidentes. Estudio histopatológico concluyó angiosarcoma cardíaco. Discusión: Los tumores cardíacos son infrecuentes. Se deben sospechar en pacientes con clínica cardiovascular, asociada a masa intracavitaria, derrame pericárdicono explicable por otra causa, así como la presencia de metástasis torácicas de un tumor primario desconocido...

Introduction: Cardiac tumors are rare; of them, the metastatic tumors are the most frequent. Of the primary tumors, only 25 percent are malignant, being the angiosarcoma the most common. It is a tumor of high malignancy, characterized by rapid growth, obstruction of cardiac valves and lung metastases. It is most common between 30 and 50 years, especially in men, with a ratio of 2:1. Its symptoms are nonspecific cardiovascular and its prognosis is poor, with a survival of nine to twelve months from diagnosis. Case report: A 50 years old woman with a history of hypertension and rheumatoid arthritis. She presented with dyspnea and impaired functional capacity. Transthoracic echocardiogram showed a mass of 6 cm in diameter, occupying the entire right atrium with tricuspid flow obstruction, associated with massive pericardial effusion with cardiac tamponade. Computed tomography (CT) of the brain, thorax, abdomen and pelvis discarded metastatic lesions. Surgical treatment was decided. The tumor and 70 percent of the free wall of the atrium were resected and biological prosthetic valve was installed, and the righ tatrium was reconstructed with autologous pericardium. She evolved favorably, without incident. Histopathological reports confirmed cardiac angiosarcoma. Discussion: Cardiac tumors are rare. They should be suspected in patients with cardiovascular symptoms, associated with intracavitary mass, pericardial effusion not explained by other causes, as well as the presence of thoracic metastases from an unknown primary tumor...