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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 152-153

Intracardiac foregut cyst, in a 42-year-old woman with partial atrioventricular septal defect, a rare incidental finding


Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran

Date of Web Publication10-Sep-2018

Correspondence Address:
Dr. Hooman Bakhshandeh
Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave., Niayesh Blvd., Tehran
IR Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/rcm.rcm_13_18

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  Abstract 


A 42-year-old female with gradual-onset dyspnea on exertion and a systolic murmur is presented, in whom electrocardiogram showed left axis deviation with an Rsr' pattern in lead V1. Chest X-ray had a pulmonary vascular shunt and echocardiography marked a large ostium primum atrial septal defect together with a cleft in the mitral valve, leading to a diagnosis of the partial atrioventricular septal defect. Furthermore, magnetic resonance imaging depicted an incidental cyst on the roof of the left atrium. The operation was performed, and the cyst was excised. It measured 15 mm in diameter, had a fibrotic wall and contained homogeneous gelatinous material. Histopathology showed a small simple cyst with a fibrotic wall, lined by cuboidal to respiratory-type columnar cells. No evidence of malignancy was noted. The patient had an uneventful postoperative course and was discharged in good clinical condition.

Keywords: Bronchogenic cyst, heart septal defects, congenital


How to cite this article:
Mozaffari K, Khajali Z, Givtaj N, Bakhshandeh H. Intracardiac foregut cyst, in a 42-year-old woman with partial atrioventricular septal defect, a rare incidental finding. Res Cardiovasc Med 2018;7:152-3

How to cite this URL:
Mozaffari K, Khajali Z, Givtaj N, Bakhshandeh H. Intracardiac foregut cyst, in a 42-year-old woman with partial atrioventricular septal defect, a rare incidental finding. Res Cardiovasc Med [serial online] 2018 [cited 2018 Dec 17];7:152-3. Available from: http://www.rcvmonline.com/text.asp?2018/7/3/152/240987




  Introduction Top


Here, we discuss a rare case report, the aim of which is to present an incidentally found congenital anomaly, not a neoplasm. Echocardiography, cardiac magnetic resonance imaging (MRI), and histopathology serve as clues to a better approach.


  Case Report Top


We present a 42-year-old female with a chief complained of dyspnea on exertion of gradual onset. Her physical examination revealed a systolic murmur over the pulmonary valve area but was otherwise unremarkable. The electrocardiogram showed left axis deviation with an Rsr' pattern in lead V1. Her chest X-ray portrayed the evidence of a pulmonary vascular shunt and echocardiography further revealed a large ostium primum atrial septal defect together with a cleft in the mitral valve. These echocardiographic findings lead to a diagnosis of partial atrioventricular septal defect (AVSD). Given the small size of the left ventricle (LV) and to better evaluate the size and the volume of LV regarding operability, a cardiac MRI was requested. Later, MRI depicted the LV size at the lower limit of normal and interestingly enough, an incidental cyst was found on the roof of the left atrium [Figure 1]. The operation was performed on the patient, which consisted of AVSD repair and cyst excision. The cyst measured 15 mm in diameter, had a fibrotic wall, and contained homogeneous gelatinous material. Grossly, the specimen consisted of soft and creamy-gray fragments, 1.5 cm in diameter. The histopathological examination showed a small, simple cystic structure with a fibrotic wall, lined by cuboidal to columnar cells [Figure 2]. The latter was reminiscent of the ciliated respiratory-type epithelium. Neither evidence of malignancy was noted nor was any neuroectodermal element to suggest a probable diagnosis of a mediastinal teratoma. The patient had an uneventful postoperative course and was discharged in good clinical condition.
Figure 1: Arrow shows the position of a 15 mm cyst on the roof of the left atrium

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Figure 2: Fibrous tissue forms a cyst wall, lined by columnar epithelium where some cilia are identified (H and E, ×100)

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  Discussion Top


Foregut cysts appear as a result of anomalous embryonic development. A sac-like cyst may be pinched off during this developmental period, being carried into the mediastinum as a result of the downward growth of the lungs. This cyst contains endodermal and mesodermal elements that were to become a part of the respiratory tract, esophagus, stomach, or intestine. Therefore, the foregut cyst, which is a general term encompasses bronchogenic, esophageal, gastric, or enteric cysts. Bronchial cysts are noted along the tracheobronchial tree, most commonly posterior to the carina or rarely, above the diaphragm. These cysts have clear or gelatinous fluid and are predominantly unilocular with a thin wall. Their average size is about 3–4 cm. Microscopically, it is usual to see ciliated columnar epithelium and foci of squamous metaplasia.[1] Intracardiac foregut cysts can be diagnosed with transthoracic echocardiography as a space-occupying lesion with compressive effects; hence, the reduction in cardiac function or blood flow obstruction. Diagnosis is by histopathology, in which, we see endodermal and mesodermal elements. Teratomas are the main differential diagnosis of foregut cysts, in which, we see ectodermal elements too.[2] Intracardiac bronchogenic cysts are extremely rare, with only three cases reported previously. A similar lesion was found in a 70-year-old male who had a bronchogenic cyst in interatrial septum and a concomitant persistent left superior vena cava.[3] We presented this case because of its rarity and association with congenital heart disease, partial AVSD. Whereas, these cysts occur usually in the mediastinum, the heart is an atypical location for such lesions, and in our case report, we have described a rare lesion in a yet rarer location.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rosai J. Rosai and Ackerman's Surgical Pathology. 10th ed. Edinburgh: Mosby Company; 2011. p. 439-40.  Back to cited text no. 1
    
2.
Huang JH, Rudzinski ER, Minette MS, Langley SM. First case of intracardiac foregut cyst occurring in the left-ventricular outflow tract. Pediatr Cardiol 2013;34:2060-2.  Back to cited text no. 2
    
3.
Chen CC. Bronchogenic cyst in the interatrial septum with a single persistent left superior vena cava. J Chin Med Assoc 2006;69:89-91.  Back to cited text no. 3
    
4.
Vaideeswar P, Agnihotri MA, Patwardhan AM. Intracardiac bronchogenic cyst. J Card Surg 2011;26:266-8.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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