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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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CLEAR FILTERS
Mysteries of the Heart
Session:
CASOS CLÍNICOS DE INSUFICIÊNCIA CARDÍACA E CUIDADOS INTENSIVOS
Speaker:
Lourenço Aguiar
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Lourenço Aguiar; Joana Araújo Correia; António Leão; Paulo Reisinho; Vilma Laís Grilo; Ana Luísa Broa; João Mirinha Luz; Inês Cruz; Sofia Carralas Antunes; Jorge Oliveira; Otília Simões; Hélder Pereira
Abstract
<p>An 83-year-old female with a history of type 2 diabetes, hypertension, dyslipidemia, and anticoagulated atrial fibrillation, presented repeatedly to the emergency department with left lumbar pain radiating to the flank and postprandial vomiting. She denied fever, chest pain, or dyspnea. Initial tests showed anemia and elevated inflammatory markers. CT angiography of the abdomen and pelvis revealed spastic areas in the ascending colon, hyperdense content in the ileum and colon, and suggested pulmonary embolism (PE), later confirmed on chest CT angiography, with identification of a thrombus in the pulmonary trunk, classified as low risk. The patient was admitted for further investigation and management.</p> <p>A transthoracic echocardiogram performed for PE risk stratification revealed masses near the tricuspid valve annulus and right ventricular outflow tract, the first large, sessile, multilobulated, and the second elongated and mobile, extending to the pulmonary valve. These findings suggested endocarditis or a neoplastic mass. However, infectious and autoimmune screenings for endocarditis were negative and CT scans of the thorax, abdomen, and pelvis performed on admission showed no tumoral lesions. A cardiac MRI was then performed and showed a mass with increased mobility, continuous with the tricuspid valve leaflet/ring, protruding into the right ventricular outflow tract. The mass was isointense on T1 and hyperintense on T2-weighted sequences, with peripheral contrast uptake but no enhancement inside the mass, excluding thrombus presence and suggesting a primary cardiac neoplasm, likely rhabdomyoma or rhabdomyosarcoma.</p> <p>Throughout her hospitalization, her condition deteriorated, with worsening anemia, thrombocytopenia, congestive heart failure, respiratory infection, and liver injury. The patient passed away on the 33rd day of hospitalization. An autopsy confirmed that the intracardiac mass was a metastasis from biliopancreatic adenocarcinoma, with further metastases to the lungs and adrenal glands.</p> <p>Cardiac metastases can occur in up to 10% of patients, more frequently associated with lung cancer. The most common finding is pericardial effusion. Rarely, transvenous extension can lead to intracavitary/intraluminal metastasis, more commonly in renal cell, adrenocortical and hepatocellular carcinomas. In general, metastases on MRI are hypointense on T1 and heterogeneously hyperintense on T2-weighted sequences with variable enhancement.</p>
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