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(Circulation. 1998;97:1523-1524.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Intrapericardial Teratoma

Maurice Beghetti, MD; Mark Prieditis, MD; Ivan M. Rebeyka, MD, FRCSC; John Mawson, MBChB; ; FRACR, FRCPC

From the Divisions of Cardiology (M.B.) and Cardiovascular Surgery (I.M.R.) and the Department of Diagnostic Imaging (M.P., J.M.), The Hospital for Sick Children, University of Toronto, Canada.

Correspondence to Dr John Mawson, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.

A 1-month-old boy presented with signs of heart failure and tamponade. Two-dimensional echocardiography revealed a complex mass with a large pericardial effusion compressing the heart. Magnetic resonance imaging (Fig 1) defined the relationship of the mass to the pericardium, myocardium, and great vessels. Complete surgical resection was performed without complication (Fig 2). Histology of the mass confirmed the presumptive imaging diagnosis of teratoma. The patient remains free of symptoms and tumor 1 year after surgery.

View larger version (115K): [in this window] [in a new window]   Figure 1. Magnetic resonance imaging. Axial T1-weighted spin-echo images. A, Main tumor mass (*) is seen displacing mediastinal structures. Thymus (THYM) is displaced rightward and superiorly (not shown), while aorta (AO) and main pulmonary artery (MPA) are displaced posteriorly and splayed. B, Intrapericardial nature of the tumor is demonstrated on a lower image, with tongues of tumor (*) projecting into pericardial space, indenting right atrium (RA). There is an effusion (Eff) and pericardial thickening (arrowheads). LA indicates left atrium.

View larger version (105K): [in this window] [in a new window]   Figure 2. Gross specimens following surgical resection. A, Tumor bulk is clearly seen, as are two tumor tongues (*) identified in Fig 1B. B, On cut section, cystic and solid nature of lesion is demonstrated, correlating well with variations in signal intensity seen in main tumor mass in Fig 1A.

Intrapericardial teratomas are rare primary cardiac tumors usually diagnosed in neonates and infants.^{1 2} They contain endodermic, mesodermic, and neuroectodermic germinal layers.³ Intrapericardial teratomas are usually benign tumors but may be life-threatening because of large pericardial effusion and cardiac compression.^{1 2} Echocardiography generally suggests the diagnosis by showing a heterogeneous intrapericardial mass associated with a pericardial effusion compressing the heart.²

Two-dimensional echocardiography is considered to be the best diagnostic imaging modality for primary cardiac tumors, but magnetic resonance imaging may have advantages with large tumors in defining the relationship of the tumor to adjacent structures, in visualizing echocardiographic "blind" spots, and in defining tissue characteristics.

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 Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

References

1. Sumner TE, Crowe JE, Klein A, McKone RC, Weaver RL. Intrapericardial teratoma in infancy. Pediatr Radiol. 1980;10:51–53.[Medline] [Order article via Infotrieve]

2. Seguin JR, Coulon PL, Perez M, Grolleau-Raoux R, Chaptal PA. Echocardiographic diagnosis of an intrapericardial teratoma in infancy. Am Heart J. 1987;113:1239–1240.[Medline] [Order article via Infotrieve]

3. Brabham KR, Roberts WC. Cardiac-compressing intrapericardial teratoma at birth. Am J Cardiol. 1989;63:386–387.[Medline] [Order article via Infotrieve]

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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 Beghetti, M. Articles by FRACR, J. Search for Related Content PubMed PubMed Citation Articles by Beghetti, M. Articles by FRACR, J. Pubmed/NCBI databases Medline Plus Health Information MRI Scans