PMC6262358_01
Chest computed tomography. (A) Transverse section. The intrapericardial tumor (asterisk) lies between ascending aorta (AAo), pulmonary trunk (PT), and left pulmonary vein (LPV). It contains two macrocalcifications (white arrows) and is modeled by the left main coronary artery (black arrow). (B) Coronal section. Left atrium (LA) is slightly compressed by the tumor without any signs of invasion. Left ventricle (LV) models inferior part of the tumor, PT models its superior part.
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F1
Tomography (CT; Siemens, Germany) of the chest. There were no significant changes in the lungs, however, CT (Figure 1) revealed the presence of a giant intrapericardial tumor with the dimensions of 80 x 38 x 32mm. CT coronary angiography and 3-dimensional reconstruction (Figure 2 and Supplementary Figure 1) were applied to enable precise planning of cardiac surgery.
Heart computed tomography, 3-dimensional reconstruction. (A) The tumor (asterisk) is located posteriorly and laterally to the pulmonary trunk (PT) and the ascending aorta (AAo), superiorly to the left ventricle (LV). (B) Macrocalcificacion (black arrow) as a part of the tumor's structure.
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F2
CT coronary angiography and 3-dimensional reconstruction (Figure 2 and Supplementary Figure 1) were applied to enable precise planning of cardiac surgery. Transthoracic echocardiography confirmed the tumor location; there were no signs of valvular disease, nor heart failure (Supplementary Figure 2).
Intraoperative image and histopathology of the tumor. (A) Cardiac surgery. Transverse intersection of the aorta and the pulmonary trunk exposed the intrapericardial tumor (asterisk). (B) Macroscopic section of bisected mass. The scale indicates its longitudinal dimension of 75 mm. (C) Microscopic section. Hematoxylin and eosin-stained histology image of the tumor. A blood vessel surrounded by myxoid cells (black arrow). Microcalcifications and degenerative changes are embedded in profuse hyalinized stroma (white arrow).
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F3
A cohesive, smooth, vascularized tumor pedunculated to the left atrial epicardium was visualized (Figure 3A). Histological evaluation (Figures 3B,C and Supplementary Figure 3 revealed the presence of myxoid cells, blood vessels, degenerative changes, microcalcifications embedded in profuse hyalinized stroma, and the absence of papillary structures.