Cardiac Fibroma Resulting in Fatal Ventricular Arrhythmia
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 Despite aggressive antiarrhythmic therapy, the patient’s cardiac rhythm deteriorated further, and support was withdrawn after signs of irreversible multisystem organ failure developed.
Postmortem examination revealed a 7×4×4-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⇓).
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.
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