Quick Fire Cases
Jorge A. Paz, MD
Fellow in Training
CT Scanner, Mexico
Jorge A. Paz, MD
Fellow in Training
CT Scanner, Mexico
Jorge A. Silva Estrada, MD
CMR and CT Consultant
CT Scanner, Mexico
Ana Rosas, MD
CMR and CT consultant
CT Scanner Lomas Altas, Mexico
Moises Jimenez, MD
CMR and CT Consultant
CT Scanner, Mexico
Laura Victoria Torres-Araujo, MD
CMR honorary research fellow
Royal Brompton Hospital, Mexico
Luz Dinora Sandoval, MD
CMR and CT Consultant
CT Scanner, Mexico
Maribel Jimenez Toxqui, MD
CT and CMR Consultant
CT scanner, Mexico
Carlos Sanchez, MD
CT and CMR Consultant
CT Scanner, Mexico
Andrea Salas, MD
Fellow in Training
CT Scanner, Mexico
Liliana Zarco, MD
Fellow in Training
CT Scanner, Mexico
Tuberculosis has the potential of causing cardiovascular disease, primarily affecting the pericardium, myocardium and, less frequently coronary arteries. Intracardiac tuberculoma is quite rare and sometimes described in postmortem studies.
We present the case of a 4-year-old boy who presented with a 4 month history of back pain, fever, weight loss and fatigue. A computed tomography scan revealed a mass in the right frontal lobe of the brain with perilesional edema and cranial lytic lesions and osteolytic lesions in several thoracic vertebrae. A transthoracic echocardiogram showed an hyperechogenic mass in the left ventricle.
Diagnostic Techniques and Their Most Important Findings:
Cardiac magnetic resonance allowed visualization of an ovoid-shaped mass with well-defined borders. It measured 19 x 13 x 20 mm and it had a broad base attached to the mid interventricular ventricular septum. The mass was isointense in cine bSSFP sequences, isointense with a hypointense core in T1, and heterogeneous core with thin hyperintense rim in T2W images. During first-pass perfusion the mas showed no enhancement, in early
and late gadolinium enhancement sequences there was a hypointense core with a hyperintense peripheral rim.
The intracranial and vertebral lesions alongside the left ventricle cardiac mass strongly suggesting caseating granuloma led to a strong suspicion of disseminated tuberculosis. Positive PCR test and Ziehl Nielsen-stained bacilli were obtained from biopsies taken from the lesions in the brain and vertebrae. Anti tuberculosis treatment was initiated according to institutional protocol. Surgery was withheld after follow up echo and a second cardiac MR showed reduction in size of the lesion. After a 10-month-follow-up a cardiac magnetic resonance showed complete resolution of the left ventricle mass with normal biventricular ejection fraction.
Learning Points from this Case:
Intracardiac tuberculomas is an infrequent and potentially fatal complication of disseminated tuberculosis. Tissue characterization through magnetic resonance proves to be useful for diagnosis, extension assessment and follow up. Successful treatment of a large cardiac tuberculoma with drug therapy alone and without further cardiovascular complications makes a once-in-a-lifetime scenario.
