Case Report: Mediastinal Tuberculoma Mimicking a Malignant Cardiac Tumor

The clinical manifestations of cardiac masses are diverse and lack specificity. Here we report a cardiac mass detected by transthoracic echocardiography. Multimodality imaging and pathological findings after the operation confirmed the mass as mediastinal tuberculoma.

Case Presentation

A 45-year-old male patient was admitted to our hospital reporting chest tightness, weight loss, and dyspnea for 3 months after exercise. Transthoracic echocardiography showed that there were a large number of pericardial effusions and the soft tissue mass measuring 7.7 cm × 4.5 cm in the upper mediastinum, which oppressed the right pulmonary artery and accelerated the blood flow of the left pulmonary artery.

Contrast-enhanced ultrasonography showed degenerative inhomogeneous high enhancement of and an unclear boundary in the mass. Contrast-enhanced chest CT revealed punctate and patchy calcification in and uneven enhancement of the mass and the lymph nodes around the aortic arch. The mass was diagnosed as a malignant mediastinal tumor. Pathological analysis of the mass revealed chronic granulomatous tuberculosis. The symptoms abated significantly after antituberculosis treatment. The patient remained asymptomatic during follow-up.

Conclusion

This report presents a rare case of mediastinal tuberculoma mimicking a malignant cardiac tumor. Multimodality imaging should be incorporated for differentiation of cardiac masses.

Publication Details

In a new publication from Cardiovascular Innovations and Applications; DOI: https://doi.org/10.15212/CVIA.2019.0587, Yiqian Ding, Wei Li, Yanqiu Liu, Min Ye, Liangping Cheng, Donghong Liu, Hong Lin, and Fengjuan Yao from The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China consider mediastinal tuberculoma mimicking malignant cardiac tumors.

In this report, the authors present a rare case of mediastinal tuberculoma mimicking a malignant cardiac tumor before operation and was finally diagnosed as cardiac tuberculoma by postoperative pathological examination. The clinical manifestations of cardiac masses are diverse and lack specificity, which makes it difficult for clinicians to detect and distinguish cardiac masses. Cardiac tumors are rare but can be associated with high morbidity and mortality.

Discussion

In recent years, more and more noninvasive imaging methods have been used for cardiac lesions. Two-dimensional echocardiography is considered to be a guiding standard imaging examination for the evaluation of cardiac masses. Contrast-enhanced perfusion echocardiography (CEUS) has advantages in distinguishing masses from benign and malignant tumors.

Although the case was initially not diagnosed by echocardiography and CT because of the variability of tuberculosis, Transthoracic echocardiography (TTE) is still considered the first line imaging modality for the assessment of cardiac masses. CEUS can confirm the presence of a cardiac or mediastinal mass and provide information on perfusion, which is used to complement TTE with improved detection of benign or malignant masses. Multimodality imaging in the evaluation of cardiac masses plays a pivotal role.

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