BACKGROUND Hepatocellular carcinoma(HCC)is the most important primary malignant liver disease.A large proportion of patients with advanced HCC have macrovascular invasion.HCC tends to infiltrate vascular structures,pa...BACKGROUND Hepatocellular carcinoma(HCC)is the most important primary malignant liver disease.A large proportion of patients with advanced HCC have macrovascular invasion.HCC tends to infiltrate vascular structures,particularly the portal vein and its branches,and more rarely,the hepatic veins.The intravascular tumor thrombus can affect the inferior vena cava(IVC)or even the right atrium(RA),the latter having a poor prognosis.CASE SUMMARY HCC is one of the most aggressive malignant tumors.Tumor thrombus(TT)formation in advanced HCC stages is common and usually involves the hepatic or portal veins.Herein,we report a 69-year-old woman who presented with dyspnea to the emergency department.A ventilation/perfusion lung scan was performed,ruling out pulmonary embolism.Hepatopulmonary syndrome and portopulmonary hypertension were discarded with contrasted echocardiography,but a mass in the RA was detected and confirmed by cardiac magnetic resonance imaging.Abdominal computed tomography showed a liver mass with a dynamic enhancement pattern compatible with HCC and an intraluminal IVC mass extending from the hepatic vein into the RA.HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.CONCLUSION HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.There is no consensus about anticoagulation or other interventions in these patients.展开更多
We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve repl...We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was rehospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors.展开更多
In this paper,eleven consecutive hepatocellular carcinoma(HCC) patients with an embolus in the hepatic vein(HV),inferior vena cava(IVC)and right atrium(RA) were studied with 18F-FDG PET/CT and contrast enhanced CT.Whe...In this paper,eleven consecutive hepatocellular carcinoma(HCC) patients with an embolus in the hepatic vein(HV),inferior vena cava(IVC)and right atrium(RA) were studied with 18F-FDG PET/CT and contrast enhanced CT.When correlated with final diagnosis,18F-FDG PET/CT and contrast enhanced CT was positive in 11 patients(100%),7 patients(63.6%),respectively.The accuracy of PET/CT and contrast-enhanced CT were 100%,63.6%.Three cases with secondary blood thrombi in the distant IVC,which were confirmed by PET/CT,cannot be identified by contrast enhanced CT.The average survival was 3 months(range,1-12mo).The 12 months survival rate was 9.1%.Our results suggest that highly metabolic tumor thrombus in the HV,IVC and RA may be depicted on 18F-FDG PET/CT in HCC patients.It may discriminate between malignant and secondary benign blood thrombi.展开更多
BACKGROUND Renal cell carcinoma(RCC)is an aggressive tumor,with an incidental discovery in most patients.Classic presentation is rare,and it has a high frequency of local and distant metastasis at the time of detectio...BACKGROUND Renal cell carcinoma(RCC)is an aggressive tumor,with an incidental discovery in most patients.Classic presentation is rare,and it has a high frequency of local and distant metastasis at the time of detection.CASE SUMMARY We present a rare case of a 58-year-old man with a ball-shaped thrombus in the right atrium at the time of first incidental identification of RCC in the emergency department.Cardiac metastasis,especially thrombus in the right atrium,is rare.It could either be a bland thrombus or a tumor thrombus,and physicians should consider this potentially fatal complication of RCC early at the time of initial presentation.CONCLUSION Ball-shaped lesions in the right atrium are rare,and bland thrombus should be differentiated from tumor thrombus secondary to intracardiac metastasis.展开更多
Background: Recent observational studies have suggested that the patients with hyperuricemia have a higher risk of having left atrial thrombus (LATH) or left atrial spontaneous echo contrast (LASEC) by transesophageal...Background: Recent observational studies have suggested that the patients with hyperuricemia have a higher risk of having left atrial thrombus (LATH) or left atrial spontaneous echo contrast (LASEC) by transesophageal echocardiography (TEE), while the ultimate predictive value of a high uric acid (UA) level on LATH/LASEC remained obscure. Methods: We searched the PubMed and Cochrane clinical trials databases up to July 2015. Following screening the 369 initially identified studies, we analyzed six observational studies with 2381 patients. Results: The meta-analysis of these studies showed that an elevated serum UA level was associated with a higher likelihood of LATH/LASEC (OR ? 1.59, 95%CI 1.13e2.23, P ? 0.008), while significant differences exist among individual trials (P<0.00001 and I2 ? 85%). Sensitivity analysis failed to find any heterogeneity. Conclusion: An elevated UA level was associated with a higher risk of detecting a left atrial abnormality represented by LATH/LASEC.展开更多
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the most important primary malignant liver disease.A large proportion of patients with advanced HCC have macrovascular invasion.HCC tends to infiltrate vascular structures,particularly the portal vein and its branches,and more rarely,the hepatic veins.The intravascular tumor thrombus can affect the inferior vena cava(IVC)or even the right atrium(RA),the latter having a poor prognosis.CASE SUMMARY HCC is one of the most aggressive malignant tumors.Tumor thrombus(TT)formation in advanced HCC stages is common and usually involves the hepatic or portal veins.Herein,we report a 69-year-old woman who presented with dyspnea to the emergency department.A ventilation/perfusion lung scan was performed,ruling out pulmonary embolism.Hepatopulmonary syndrome and portopulmonary hypertension were discarded with contrasted echocardiography,but a mass in the RA was detected and confirmed by cardiac magnetic resonance imaging.Abdominal computed tomography showed a liver mass with a dynamic enhancement pattern compatible with HCC and an intraluminal IVC mass extending from the hepatic vein into the RA.HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.CONCLUSION HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.There is no consensus about anticoagulation or other interventions in these patients.
基金Supported by Swiss National Science Foundation,No.310030_118245 and No.32003B_134963/1
文摘We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist(VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was rehospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors.
基金Supported by National Science Foundation for Young Scholars of China (Grant No. 81101067)
文摘In this paper,eleven consecutive hepatocellular carcinoma(HCC) patients with an embolus in the hepatic vein(HV),inferior vena cava(IVC)and right atrium(RA) were studied with 18F-FDG PET/CT and contrast enhanced CT.When correlated with final diagnosis,18F-FDG PET/CT and contrast enhanced CT was positive in 11 patients(100%),7 patients(63.6%),respectively.The accuracy of PET/CT and contrast-enhanced CT were 100%,63.6%.Three cases with secondary blood thrombi in the distant IVC,which were confirmed by PET/CT,cannot be identified by contrast enhanced CT.The average survival was 3 months(range,1-12mo).The 12 months survival rate was 9.1%.Our results suggest that highly metabolic tumor thrombus in the HV,IVC and RA may be depicted on 18F-FDG PET/CT in HCC patients.It may discriminate between malignant and secondary benign blood thrombi.
文摘BACKGROUND Renal cell carcinoma(RCC)is an aggressive tumor,with an incidental discovery in most patients.Classic presentation is rare,and it has a high frequency of local and distant metastasis at the time of detection.CASE SUMMARY We present a rare case of a 58-year-old man with a ball-shaped thrombus in the right atrium at the time of first incidental identification of RCC in the emergency department.Cardiac metastasis,especially thrombus in the right atrium,is rare.It could either be a bland thrombus or a tumor thrombus,and physicians should consider this potentially fatal complication of RCC early at the time of initial presentation.CONCLUSION Ball-shaped lesions in the right atrium are rare,and bland thrombus should be differentiated from tumor thrombus secondary to intracardiac metastasis.
基金a grant (No.81270245 to T.L.) from the National Natural Science Foundation of China
文摘Background: Recent observational studies have suggested that the patients with hyperuricemia have a higher risk of having left atrial thrombus (LATH) or left atrial spontaneous echo contrast (LASEC) by transesophageal echocardiography (TEE), while the ultimate predictive value of a high uric acid (UA) level on LATH/LASEC remained obscure. Methods: We searched the PubMed and Cochrane clinical trials databases up to July 2015. Following screening the 369 initially identified studies, we analyzed six observational studies with 2381 patients. Results: The meta-analysis of these studies showed that an elevated serum UA level was associated with a higher likelihood of LATH/LASEC (OR ? 1.59, 95%CI 1.13e2.23, P ? 0.008), while significant differences exist among individual trials (P<0.00001 and I2 ? 85%). Sensitivity analysis failed to find any heterogeneity. Conclusion: An elevated UA level was associated with a higher risk of detecting a left atrial abnormality represented by LATH/LASEC.
