Contribution of 3D echocardiography in the context of a mass located in the RV exploration

A patient of 72 years old was admitted for a right pulmonary embolism associated with a flutter. The 2D echo discovered two very mobiles echoes, attached in the region of the infundibulum of right ventricle. The 3D echo (IE-33, Philips) performed at the same time (transthoracic and transesophageal real-time acquisition followed by a post-treatment) accurately defi – ned the location and the size of these echoes (greater (20x9x9 mm) is attached on the anterior-left wall of the infundibulum to 20 mm of the pulmonary valve; smaller (7x6x6 mm) being attached regarding of the aortic root, close to the anterior tricuspid commissure). There are no spontaneous contrast, the contractility of the walls and the infundibular region and generally RV is normal. Cardiac CT describes a mass that enhances heterogeneously, partly calcified, located at the infundibulum of RV, whose size suggests a tumor.Cardiac MRI discovers an image rounded 10 mm, the tissue characterization is impossible.The right ventricular masses is difficult to puncture because of the risk of embolization, the patient was put on anticoagulant therapy. When the new hospitalization, three months later, transthoracic and transesophageal 2D – 3D echos shows the increase in size of the echoes detected during the previous review: 23x14x9mm for the largest, 7x6x6 mm for the smallest.There is in addition the appearance of a third echo sized 10x5x5mm attached at the septal band. The function of VD this time is altered, there is important TR by expansion of the ring (40x40mm), the PASP is 59 mm Hg.The scanner (average quality due to irregular heart rate) describes several masses of infundibular location; the most voluminous 17mm, up from the previous scan. Conclusion: It is a patient of 71 years old with three pedunculated intra right ventricular masses, probably tumoral origin (persistence same growth masses despite anticoagulation, microcytic anemia, weight loss being in favor neoplasia). The etiologic exploration of these masses is in progress (scheduled biopsy). The echo 3D made it possible to define the dimensions and the insertion points of the 2 mobiles masses detected during the initial examination, to note their growth between the 2 hospitalizations, like detecting the appearance of the new 3rd mass.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)