Left Ventricular Mass After Treatment With Chemotherapic Drugs
A 23-year-old man with acute myeloid leukemia had been treated with chemotherapic agents and an autologous stem cell transplant at the age of 11 and had received a transplant of matched unrelated donor stem cells at the age of 22 for myelodysplastic syndrome. During a recent hospitalization for lung impairment, chest x-ray, computed tomography scan, and sputum cultures were suggestive of fungal infection with Aspergillus pneumoniae, and the patient was treated with Amphotericin B (GILEAD Sciences) and Caspofungin (Merck-Sharpe&Dohme Ltd) for 1 month. Three months after discharge, he underwent cardiac evaluation because of systemic hypertension. Two-dimensional echocardiography showed an oval (1.2×1.4 cm) floating mass in the left ventricular outflow tract near the aortic valve (Figure 1A and 1B). With the aid of cardiopulmonary bypass, cardioplegic arrest, and transverse aortic incision, the mass was excised from its base on the ventricular septum, 3 centimeters below the commissure between the right and left aortic cusps. The mass (Figure 2A) was whitish, friable, and oval shaped with a rough surface. Histologically, it consisted of characteristic branching septate hyphae enmeshed within fibrinous material (Figure 2B). With a diagnosis of left ventricular aspergilloma, the patient was treated with Voriconazole (Pfizer) for 7 weeks. No echocardiographic evidence of recurrence was present at the 4 months’ follow-up.
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/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.