Left Atrial Thrombus Mistaken as a Tumor after Heart Transplantation

Abstract

The occurrence of neoplastic malignancy due to chronic immunosuppression in heart transplant recipients is a well-known threat. Continuous check-ups are therefore mandatory in this patient group. We describe the case of a 58-year-old man transplanted for dilated cardiomyopathy. During regular diagnostic check-up, a solid mass in the left atrium was discovered on the transesophageal echocardiogram. Since the mass became progressively larger over three years and showed features of neither myxoma nor thrombus, a cardiac sarcoma was suspected. A secondary diagnostic magnetic resonance tomography (MRT) investigation was contraindicated due to an implanted pacemaker. Intraoperatively, the mass proved to be an organized thrombus. Surgery had to be performed without an established accurate diagnosis due to a suspected malignancy in chronically immunosuppressed patients.

Key words

Heart transplantation - immunosuppression - tumor - atrial thrombus

References

• 1 Cole W. The increase in immunosuppression and its role in the development of malignant lesions.  J Surg Oncol. 1985;  30 139-144
• 2 Catena F, Nardo B, Liviano d'Arcangelo G. et al . De novo malignancies after organ transplantation.  Transplant Proc.. 2001;  33 1858-1859
• 3 Chitwood W R. Cardiac neoplasms: current diagnosis, pathology and therapy.  J Cardiac Surg. 1988;  3 119-154
• 4 Mueller J, Eubel A, Dandel M, Hummel M, Hetzer R. Non-invasive monitoring of rejection after cardiac transplantation.  Dtsch Med Wochenschr. 2001;  126 1223-1228
• 5 Starzl T E, Groth C G, Brettschneider L. et al . Orthotopic homotransplantation of the human liver.  Ann Surg. 1968;  168 416
• 6 Penn I, Hammond W, Brettschneider L, Starzl T E. Malignant lymphomas in transplantation patients.  Transplant Proc. 1969;  1 106-112
• 7 Caforio A LP, Tursi V, Brombin M, Feltrin G, Anmgelini A, Livi U. Heart transplantation in patients with neoplastic disease.  Transplant Proc. 1998;  30 1928
• 8 Edwards B S, Hunt S A, Fowler M B, Valantine H A, Stinson E B, Schroeder J S. Cardiac transplantation in patients with preexisting neoplastic disease.  Am J Cardiol. 1990;  65 501-504
• 9 Meyding-Lamade U, Krieger D, Schnabel P. Cerebral metastases of an allogenic renal cell carcinoma in a heart recipient without renal cell carcinoma.  J Neurol. 1996;  243 425-427
• 10 Rankin J M, Hartland G D, Ireland M A. Right atrial thrombus mimicking myxoma in a heart transplant recipient.  Am Heart J. 1996;  132 452-454
• 11 Kinney E L, Wright R J. Efficacy of treatment of patients with echocardiographically detected right-sided heart thrombi: a metaanalysis.  Am Heart J. 1989;  118 569-573

Correspondence