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(Circulation. 2000;101:e168.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Cardiac Fibroma Resulting in Fatal Ventricular Arrhythmia

Jeffrey A. Wong, MD; Michael C. Fishbein, MD

From the Division of Pediatric Cardiology, Cedars-Sinai Medical Center and Department of Pediatrics, University of California (J.A.W.), and the Department of Pathology and Laboratory Medicine, University of California (M.C.F.), Los Angeles.

Correspondence to Jeffrey A. Wong, MD, Division of Pediatric Cardiology, 5400 Balboa Blvd, Suite 202, Encino, CA 91316. E-mail jwong{at}mailgate.csmc.edu

A previously well and asymptomatic 6-year-old boy collapsed at school. He was initially asystolic but was resuscitated to sinus rhythm. Then, during transport to the hospital, he developed monomorphic ventricular tachycardia (Figure 1). Transthoracic echocardiography demonstrated a huge, homogeneous intramural mass in the left ventricular free wall, possibly also involving the left atrial wall, remarkably without evidence of ventricular systolic dysfunction or left ventricular outflow tract obstruction (Figure 2). Despite aggressive antiarrhythmic therapy, the patient’s cardiac rhythm deteriorated further, and support was withdrawn after signs of irreversible multisystem organ failure developed.

View larger version (132K): [in this window] [in a new window]   Figure 1. A 12-lead ECG demonstrates ventricular tachycardia. Sinus P waves can be seen to march throughout tachycardia dissociated from ventricular rhythm.

View larger version (83K): [in this window] [in a new window]   Figure 2. Transthoracic echocardiogram subcostal view demonstrates a large, homogeneous mass contiguous with posterior left ventricular wall and possibly also involving posterior left atrium. On real-time imaging, there was adequate left ventricular systolic function, although left ventricular intracavitary volume is compromised by mass. There was no left ventricular outflow or inflow obstruction by Doppler interrogation. LA indicates left atrium; LV, left ventricle; and F, fibroma.

Postmortem examination revealed a 7x4x4-cm, firm, well-demarcated intramural mass in the posterior free wall of the left ventricle (Figure 3). Microscopic examination revealed that the mass consisted primarily of fibrous tissue with focal calcifications (not shown) infiltrating the adjacent myocardium, consistent with a fibroma (Figure 4).

View larger version (117K): [in this window] [in a new window]   Figure 3. Gross pathological specimen demonstrates a 7x4x4-cm pale, tan, firm, well-demarcated intramural mass in posterior free wall of left ventricle. Abbreviations as in Figure 2.

View larger version (167K): [in this window] [in a new window]   Figure 4. Light microscopy demonstrates infiltrating border of fibroma (F) and normal myocardium (M) (trichrome stain, magnification x25).

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wong, J. A. Articles by Fishbein, M. C. Search for Related Content PubMed PubMed Citation Articles by Wong, J. A. Articles by Fishbein, M. C. Related Collections Pediatric and congenital heart disease, including cardiovascular surgery