Cardiac actinomycosis in a patient presenting with acute cardiac tamponade and a mass mimicking pericardial tumour

A case of pericardial actinomycosis mimicking a pericardial tumour is reported. After the appearance of non-specific subpleural pulmonary nodules, a 48 year old woman presented with fever and clinical signs of pericardial tamponade. Subxiphoid pericardiotomy yielded a culture negative fluid and inflammatory reactive histopathology in the pericardial biopsy specimen. Because of suspected infection cefamandole was administered for 10 days and the patient became afebrile. The pericardial effusion recurred with no clinical signs two weeks later. Steroid medication resulted in rapid regression of the pericardial effusion. Subsequent echocardiography controls showed a tumour-like pericardial mass, confirmed by cardiac magnetic imaging. Surgical exploration led to the final histological diagnosis of actinomycosis. After high dose and long term penicillin G treatment the patient recovered fully with no recurrence during two years' follow up.     

Giant right ventricular mural vegetation mimicking a cardiac tumour

Mural vegetations in the course of infective endocarditis are very rare. We report the case of a patient with an extremely large right ventricular free wall vegetation. Establishing diagnosis in the presence of only mural vegetations on echocardiography scan without valve involvement in the inflammatory process was difficult. In a differential diagnosis, benign and malignant tumours, metastases and thrombi were taken into account. The patient was operated upon and the tumour was removed successfully. A histopathological examination revealed an inflammatory character of the tumour. The patient was treated according to antibiogram and discharged home in stable condition.     

Giant cell arteritis mimicking a testicular tumour

Giant cell arteritis involving the testis was identified incidentally upon orchidectomy of a right testicular mass. The mass looked like a malignant process on ultrasound. The patient also had generalised disease and was treated appropriately. Giant cell arteritis involving the bladder, prostate, uterus, and adnexa have been described before. To our knowledge, this is the first described case of giant cell arteritis affecting the testis.     

Localized epicarditis mimicking cardiac tumor

A rare case of localized epicarditis mimicked a cardiac tumor. The diagnosis was confirmed at surgery. Epicardial peel with resection of the aneurysmal right atrial appendage resulted in complete recovery.     

Primary cardiac lymphoma mimicking infiltrative cardiomyopathy

Primary cardiac lymphoma is a rare malignancy which has been described as thickened myocardium due to the infiltration of atypical lymphocytes and accompanying intracardiac masses. Here, we report a case of a primary cardiac lymphoma without demonstrable intracardiac masses, mimicking infiltrative cardiomyopathy. A 40‐year‐old male presented with exertional dyspnoea and was diagnosed as having restrictive cardiomyopathy with severely decreased LV systolic function. Endomyocardial biopsy was performed and the diagnosis of primary cardiac lymphoma was confirmed. After appropriate chemotherapy, he recovered his systolic function fully.     

Left ventricular diverticulum mimicking cardiac tumor

Left ventricular (LV) diverticulum represents a rare and frequently asymptomatic congenital anomaly, which is incidentally discovered during routine transthoracic echocardiography. We present a case of a 66‐year‐old female patient who was admitted to the cardiology department due to incidental finding of a tumor‐like mass associated with the posterior mitral leaflet. Preliminary echocardiographic evaluation revealed a solid structure, suspected of mitral annulus calcification or LV malignancy. However, cardiac contrast‐enhanced computed tomography confirmed the presence of LV diverticulum, partially filled with calcified thrombus. Conservative management was recommended. This case underscores the importance of multimodality imaging for differentiation of LV tumor‐like structures.     

A case of pulmonary tumour embolism mimicking miliary tuberculosis

Pulmonary metastases from choriocarcinoma can very rarely give rise to a 'miliary' pattern on the chest X-ray. A 23-year-old woman with a diffuse nodular pattern on chest X-ray died due to acute respiratory failure and cor pulmonale. At autopsy, choriocarcinoma of the uterus was found. In the lungs, multiple macrovascular tumour emboli within branches of pulmonary muscular arteries in the region of segmental/subsegmental bronchi were detected. There was no evidence of pulmonary parenchymal metastases, pneumonia or tuberculosis. The 'miliary' pattern of pulmonary metastases described in cases of choriocarcinoma may be due to large vessel intra-arterial tumour emboli rather than disseminated parenchymal metastases.     

Subdivided left atrium mimicking a cardiac tumor

We describe a 25-year-old man with a subdivided left atrium. The lesion was misdiagnosed preoperatively as a cardiac tumor because echocardiographic and magnetic resonance imaging revealed a solid mass arising from the posterior wall of the left atrium. Cardiac surgery revealed a small accessory chamber draining the two left pulmonary veins. No membranous structure was evident between the chamber and the left atrium. The solid mass identified noninvasively was a hypertrophic muscle which formed a wall of the accessory chamber.     

Coronary artery aneurysms mimicking cardiac tumor.

AIMS: To discuss the diagnosis of giant coronary aneurysms. METHODS AND RESULTS: We describe three patients in whom initial echocardiographic findings suggested cardiac tumors in the right atrium. Additional examination proved the tumor-like structures to be giant atherosclerotic coronary aneurysms of either the right coronary artery or its saphenous vein coronary bypass graft. CONCLUSION: Giant coronary aneurysms are an important differential diagnosis for cardiac tumors.