Incidental Findings – ABC CARDIOL

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Fibroelastoma, an Incidentaloma Disease? – Image Cases of Fibroelastomas as Incidental Findings in Four Patients, Four Different Valves

Joana Lima Lopes et al. Antonio Freitas João Bicho Augusto

Abstract

Fibroelastomas are the second most common benign cardiac tumor. They are small avascular structures with a mean size of 9mm, ranging up to 70mm, usually attached to the heart valves’ surface (aortic and mitral are the most affected, followed by tricuspid and pulmonary valves). Their etiology is unclear, but the hypothesis of coalescence of microthrombus at the coaptation margins of valves is the most widely accepted theory. On echocardiography, they are pedicled, mobile, with a filamentous surface, and usually have a speckled appearance with echolucencies and a stippled pattern near the edges. Clinically, they may be associated with embolic phenomena; however, in most cases, the diagnosis is incidental. We present a series of four clinical cases with an incidental diagnosis of fibroelastomas across the four cardiac valves as assessed by transthoracic echocardiography (; ).

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Original Article

Incidental Tomographic Findings of Coronary Artery Calcifications: A Prevalence Study in Southern Brazil

Karen Rafaela Okaseski Scopel et al. Tássia Machado Medeiros Bibiana Natalia Porto Maicá Maria Carbonari Velho … Mariana Motta Dias da Silva Juliane Nascimento Mattos Guilherme Galante Heuser Eliane Roseli Winkelmann

Abstract

Introduction

Coronary artery calcifications (CAC) are shown to be a predictive factor of cardiovascular diseases. Computed tomography (CT) of the chest with a low-dose acquisition protocol is accurate in identifying CAC and provides incidental findings of these calcifications, which are commonly overlooked. This study will analyze the prevalence of incidental findings of calcification in coronary arteries in non-cardiac individuals undergoing chest CT.

Methods

Consecutive cross-sectional study of an analytical and descriptive nature. Individuals of both genders who underwent chest CT by referral, over 18 years of age and without heart disease were included. Data collection was carried out using medical records and a self-applied anamnesis form. The variables referring to the CAC and the extension of the impairment were obtained from the reassessment of the chest CT images available in the institution’s system. The exams were anonymized and evaluated by two experienced radiologists. P≤0.05 was considered statistically significant.

Results

397 exams were analyzed. A prevalence of calcifications was found in 176 (44%) of the cases. The existence of these coronary calcifications is related to age (p<0.001). Calcifications are related to gender (p = 0.03) with a higher odds ratio of development in men (odds ratio [OR] = 1.55). Smoking (p<0.001), sedentary lifestyle (p<0.001), systemic arterial hypertension (p<0.001), Diabetes Mellitus (p = 0.04), and dyslipidemia (p<0.001) showed a positive association.

Conclusion

The prevalence of incidental CAC findings was 44%; vary in greater numbers between mild and severe; higher odds ratio in males and increased prevalence with age. Therefore, chest CT proves to be an effective method to assess CAC, and together with the patient’s clinical history, it can be used to measure risk factors for CVD and intervene in the outcome of the condition.

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Research Letter

Thoracic and Intramyocardial Pellets, an Incidental Finding in a Patient with Acute Myocardial Infarction

Valente Fernandez-Badillo et al. Mauricio Garcia-Cardenas Diego Oliva-Cavero Jose Carlos Armendariz-Ferrari … Erick Alexanderson-Rosas Nilda Espinola-Zavaleta

Introduction

Penetrating cardiac trauma is fatal; approximately more than half of affected people die at the scene. Penetrating myocardial wounds are rare, and the retention of cardiac pellets is poorly documented in literature. There are no standardized protocols for their diagnostic and therapeutic approach until now. Clinical presentation of a shotgun injury depends on the wound size, entry site, and the injury to the great vessels. In penetrating chest trauma, both ventricles are injured with similar frequency, but the right ventricle is the most entry site because it forms most of the anterior surface of the heart.

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Incidental Finding of Retroaortic Renal Vein ‘Posterior Nutcracker Phenomenon’ Associated with Thrombosis

Milton Sérgio Bohatch Júnior et al. Amanda Fernandes Vidal da Silva Carlos Diego Ribeiro Centellas Maurício Serra Ribeiro Edwaldo Edner Joviliano

A 56-year-old woman was admitted to the emergency room with acute obstructive abdomen. She denied comorbidities or previous surgeries. Abdominal computed tomography showed cecal volvulus and an incidental finding of chronic recanalized left renal vein thrombosis with a retroaortic trajectory (posterior “nutcracker” phenomenon). She underwent exploratory laparotomy with a right colectomy and transverse ileum anastomosis. After a gradually progressed diet, she was discharged from hospital ten days after surgery. In outpatient follow-up, she denied symptoms of abdominal or flank pain, and laboratory tests showed no signs of proteinuria or hematuria. Conservative treatment and periodic follow-up were chosen considering the incidental finding of nutcracker phenomenon.

A retroaortic left renal vein is a rare anatomical variation that is asymptomatic in most cases and called posterior nutcracker phenomenon. In symptomatic cases, the term posterior nutcracker syndrome is used.^, Its exact prevalence is unknown, but it is more commonly diagnosed in female patients between the third and fourth decades of life. This compressive disorder can result in venous hypertension with renal vein dilation and ureteral and renal pelvis varicose veins and present as macroscopic and microscopic hematuria, flank pain, and proteinuria.^, Conservative treatment is used for asymptomatic or oligosymptomatic patients as described in here.

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Editorial

Nonfunctioning Adrenal Incidentalomas: The Search for Subclinical Cardiac Alterations

José Luiz Barros Pena

By definition, an adrenal incidentaloma (AI) is an asymptomatic adrenal mass detected incidentally on imaging examination not performed for suspected adrenal diseases. The prevalence of AI has been estimated to be as high as 4.2% upon evaluation of abdomen or thorax by computed tomography (CT) scans. In most cases (85%), AIs are nonfunctioning.

In this issue of Arquivos Brasileiros de Cardiologia, Sokmen et al. selected patients (Pts) following the European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. After confirming the presence of an adrenal adenoma through imaging tests, computed tomography, or magnetic resonance imaging, they excluded Cushing Syndrome through 1-mg dexamethasone suppression test (DST), pheochromocytoma by urinary fractionated metanephrine test, and primary aldosteronism.

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Original Article

Assessment of Subclinical Cardiac Alterations and Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Patients with Nonfunctioning Adrenal Incidentaloma

Gulizar Sokmen et al. Murat Sahin Dilek Tuzun Abdullah Sokmen … Hanife Bolat Ayten Oguz Adem Doganer Huseyin Nacar Kamile Gul

Abstract

Background:

Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group.

Objective:

In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI.

Methods:

Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant.

Results:

Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups.

Conclusion:

Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.

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