Key result
Transvenous endomyocardial biopsy misdiagnosed a right atrial leiomyosarcoma as an organized thrombus, leading to inappropriate management and fatal hepatic failure.
Case Report (n=1)
Transvenous endomyocardial biopsy can yield misleading results when a cardiac tumor is covered by a thrombus, highlighting the importance of relying on echocardiography and multimodality imaging.
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Biopsy confirmation essential for RA masses with IVC extension; leaves open optimal management in advanced cases.
A 62-year-old woman was admitted for the evaluation of pedal edema and ascitis. Echocardiography revealed a right atrial (RA) mass invading the interatrial septum and extending into the inferior vena cava (IVC). Contrast enhanced computerized tomography scan excluded extravascular involvement. An organized thrombus was diagnosed by transvenous endomyocardial biopsy. The patient was treated with continuous intravenous heparin, and died soon after from hepatic failure. Postmortem histologic examination revealed a leiomyosarcoma surrounded by a thrombus involving RA, IVC, and hepatic veins. Endomyocardial biopsy played a misleading role that affected patient's management.
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Auerbach et al. (1997) conducted a case report in Right atrial mass (leiomyosarcoma masked by thrombus) (n=1). Transvenous endomyocardial biopsy was evaluated. Transvenous endomyocardial biopsy misdiagnosed a right atrial leiomyosarcoma as an organized thrombus, leading to inappropriate management and fatal hepatic failure.
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