Enlarging blood cyst with atrial septal defect causing tricuspid obstruction
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CASE REPORT
Enlarging blood cyst with atrial septal defect causing tricuspid obstruction Yu‑Lien Chang1 · Kuo‑Sheng Liao2 · Hsiu‑Hsueh Tseng3 · Yin‑Tso Liu4 Received: 20 August 2019 / Accepted: 16 December 2019 © The Author(s) 2019
Abstract Blood cysts are benign tumors in nature and seldom need surgical removal. Herein, we report an 86-year-old patient with a blood cyst originating from the fossa ovalis accompanied by an atrial septal defect. The patient used the bizarre sleeping postures, including prostrating and worshiping, to relieve chest tightness. The septal base defect kept the tumor progressively enlarged with time, which contributed to a “ball-valve “effect and caused tricuspid flow obstruction. It was resolved after excision. This case report emphasizes that long-term follow-up and increased awareness are required for unpredictable intracardiac blood cyst development. Keywords Intracardiac blood cyst · Atrial septal defect · Tricuspid obstruction
Introduction Since the first report by Elsasser in 1844, intracardiac blood cysts have been believed to be rare primary tumors in adults [1]. Common locations have been reported all over the endocardium of the heart, including the mitral, tricuspid, and pulmonary valves as well as papillary muscles [2, 3]. Blood cysts from both ventricles and the atrial septum in the right atrium (RA) are seldom observed. Furthermore, blood cyst originating from the fossa ovalis accompanied by atrial septal defect (ASD) is extremely rare. ASD nearby the fossa Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-019-01281-6) contains supplementary material, which is available to authorized users. * Yu‑Lien Chang [email protected] 1
Division of Cardiovascular Surgery, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, No. 1492, Zhongshan Rd., Taoyuan District, Taoyuan 33004, Taiwan, ROC
2
Department of Pathology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC
3
Department of Education and Research, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC
4
Division of Cardiovascular Surgery, Department of Surgery, Asia University Hospital, Taichung, Taiwan, ROC
ovalis is a true septal defect, formed by incomplete atrial septation and incomplete covering of the secondary septum. We report an old patient who had a blood cyst popped out from the fossa ovalis in RA. The ASD kept the cyst enlarging with time, subsequently causing obstruction of tricuspid flow.
Case An 86-year-old male presented with progressive weakness, chest tightness, exertional dyspnea, and poor appetite in the past 2–3 months. According to his son, the patient could hardly lie down on the bed for the past 2–3 years. Instead, he always kneeled on the bed with his head leaning against his hands to relieve chest tightness to gain a few hours of sleep. The patient was a mason before his retirement in his 70s. There was no systemic disease nor other
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