Computed Tomography–Guided Biopsy of an Epicardial Mass
A 73-year-old female was referred to our institution because a right ventricular mass was suspected on echocardiography. For careful assessment of the exact tumor location, tumor dimensions, and potential tumor infiltration in cardiac and mediastinal structures, cardiac magnetic resonance imaging was performed on a 1.5-T magnetic resonance scanner consisting of an axial half-Fourier acquired single-shot turbo spin echo sequence (Figure 1a) covering the whole thorax, cine steady-state free precession (Figure 1b) images in standard long- and short-axis views, and perfusion images after contrast injection for evaluation of contrast kinetics within the tumor. Cardiac magnetic resonance imaging revealed a huge epicardial mass, which covered the right atrium, right ventricle, right ventricular outflow tract, and right coronary artery (Figure 1a, arrow). Because of a history of liposarcoma of the upper leg 2 years before, an epicardial metastasis was assumed. Because of absence of other metastasis, histopathologic verification of the tentative diagnosis was necessary before oncological therapy. Because of technical inoperability of the tumor bulk and the limited strength of the patient, a computed tomography–guided percutaneous biopsy (Figure 1d) was performed instead of an operative biopsy. Contrast-enhanced ECG-triggered multislice computed tomography allowed detection of the right coronary artery (Figure 1c, arrow) within the tumor and enabled a safe biopsy in the beating heart without adverse event. Histopathological examination revealed a B-cell lymphoma instead of the assumed sarcoma metastasis.
The online-only Data Supplement, consisting of movie files, is available with this article at http://circ.ahajournals.org/cgi/content/full/114/23/e621/DC1.