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Chest X-ray on day 1 showing cardiomegaly (cardiothoracic ratio of 0.8)
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Chest X-ray (CXR) on day 1 showed cardiomegaly (cardiothoracic ratio of 0.8) with no features of pulmonary edema [Figure 1]. Day 1 versus day 7 CXR [Figures 1 and 4] revealed progressive cardiomegaly and the appearance of pulmonary congestion.
Transthoracic echocardiography on day 2 of life showing echogenic pericardial mass surrounding the left ventricle with no intracardiac extension and mild pericardial effusion
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A postnatal echocardiogram on day 2 showed a 30 mm x 20 mm echogenic pericardial mass surrounding the left ventricle with no intracardiac extension and mild pericardial effusion [Figure 2]. Serial echocardiography assessment [Figures 2, 3, and 5] revealed a progressive enlargement of the pericardial mass, an increase in pericardial effusion, and also the involvement of myocardium, which was not obvious in the earlier images.
Echo on day 7 of life showing further increase in pericardial mass with compression of LV. LA: Left atrium, LV: Left ventricle
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A repeat echocardiogram on day 7 showed poor cardiac contractility with an increase in pericardial mass (36 mm x 23 mm) and compression of the left ventricle [Figure 3]. Serial echocardiography assessment [Figures 2, 3, and 5] revealed a progressive enlargement of the pericardial mass, an increase in pericardial effusion, and also the involvement of myocardium, which was not obvious in the earlier images.
Chest X-ray on day 7 of life showing massive cardiomegaly and pulmonary edema
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CXR showed massive cardiomegaly and severe pulmonary edema [Figure 4]. Day 1 versus day 7 CXR [Figures 1 and 4] revealed progressive cardiomegaly and the appearance of pulmonary congestion.
Echo on day 10 showing progressive increase in cardiac mass along with myocardial infiltration
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Another echocardiogram performed after 72 h (day 10) in addition to earlier findings demonstrated progressive infiltration of the myocardium which was of the same intensity as that of cardiac mass [Figure 5]. Serial echocardiography assessment [Figures 2, 3, and 5] revealed a progressive enlargement of the pericardial mass, an increase in pericardial effusion, and also the involvement of myocardium, which was not obvious in the earlier images.
Cardiac CT revealing heterogeneous well-defined soft-tissue density mass lesion on the left side of the pericardium (marked by *). CT: Computerized tomography
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An indistinct margin between mass and myocardium indicated the possibility of infiltration with no obvious intra-atrial/ventricular component [Figure 6].
Histopathological examination (Hematoxylin-eosin stain, 200 magnification) of cardiac tumor specimen showing dilated and vacuolated myocytes (marked by *). Myocytes containing radiating thin pink cytoplasmic process resembling spider cells are also seen (broad arrow)
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HPE of the excised sample showed dilated and vacuolated myocytes with radiating pink thin cytoplasmic process resembling spider cells which are strongly PAS positive [Figure 7].