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Mohamad Alrashidi, Shaumikh Adhya, Mark Monaghan, Nick Gall, Francis Murgatroyd, Real-time three-dimensional transoesophageal echocardiography during stereotactic needle biopsy of complex atrioventricular nodal tumour, European Journal of Echocardiography, Volume 12, Issue 8, August 2011, Page 638, https://doi.org/10.1093/ejechocard/jer080
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Comprehensive echocardiographic imaging allows the characterization of tissue abnormalities of complex cardiac tumours and can guide invasive procedures. We present a case of a cystic tumour of the atrioventricular (AV) node. These are rear, benign, primary cardiac tumour that can arise from the right atrium and the interatrial septum. It can cause variable degree of heart block and sudden death. Although these types of tumour have been described, most were diagnosed post-mortem. Antemortem diagnosis has been made by surgical excision; however, antemortem needle biopsy has never been reported before. A three-dimensional (3D) transoesophageal echocardiography (TOE) provided invaluable information of the cardiac mass, reliably identifying the mass location, size, and facilitating a tumour biopsy.
A 42-year-old man presented with complete heart block. A transthoracic echocardiogram demonstrated a mass in the right atrium attached to the lower aspect of the interatrial septum (Figures A and B, arrow). Contrast imaging showed a poor uptake into the mass, suggesting that it was not well perfused (Figure C, arrow; see Supplementary data online, Video S1). A TOE confirmed the location of the mass (Figure D, arrow). Transoesophageal 3D echocardiography guided the percutaneous biopsy of this mass. Figure E is still a 3D image showing the AV nodal tumour (red arrow) and the stereotactic needle is also shown (green arrow; see Supplementary data online, Video S2). FigureF is a cut-plane through the 3D volume demonstrating the tumour (red arrow) in the AV septum and the biopsy needle (green arrow; see Supplementary data online, Video S3). FiguresG and H are showing the AV tumour (red arrow) and the stereotactic needle biopsy (green arrow; see Supplementary data online, Videos S4 and S5).
