European Journal of Echocardiography Advance Access published March 18, 2011
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doi:10.1093/ejechocard/jer015
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Primary cardiac synovial sarcoma demonstrated by 3D transesophageal echocardiogram Alaa A. Mohamed1*, Abdulaziz Al-khaldi2, and Ahmad S. Omran1 1 Cardiac Science Department, King Abdulaziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia and 2Department of Cardiothoracic Surgery, King Abdulaziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia
*Corresponding author. Tel: + 966 503 618 103, Email:
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A 26-year old male patient presented with a 9 month history of progressive shortness of breath, easy fatigability, abdominal distension, and lower limb oedema. He had large bilateral pleural effusion on the chest X ray, right-axis deviation and incomplete right bundle branch block on the ECG. Transthoracic echocardiography and transoesophageal echocardiography (TEE) 2D and 3D showed a large mass within the right atrium, extending into the right ventricle and right ventricular outflow tract (Figure 1). The mass was obstructing the tricuspid valve (TV) resulting in right ventricular inflow stenosis with a mean diastolic gradient of 13 mmHg. Given haemodynamic instability, the patient was referred for urgent surgical excision to relief the TV obstruction. A large 8.5 × 4.5 cm encapsulated mass originated from the right atrioventricular (AV) groove invading the septal leaflet of the tricuspid valve was excised and TV repair with reconstruction of the TV septal leaflet, annulus, and placement of an annuloplasty ring was performed. Pathology revealed synovial sarcoma. Extensive work-up did not show any other masses. Supplementary data Supplementary data are available at European Journal of Echocardiography online.
Figure 1 (A) Transoesophageal echocardiography mid-esophageal four-chamber view, (B) transoesophageal echocardiography midesophageal short-axis view showing a large mass within the right atrium (RA) extending to right ventricle (RV), through the tricuspid valve and partially obstructing the right ventricular outflow tract (RVOT). (LA) left atrium, (LV) left ventricle, (LVOT) left ventricular outflow tract. (C– E) Multi-planar images reconstructed from 3D transoesophageal echocardiography full volume acquisition (F) showing the tumor in RA, RV (C) partially obstructing the RVOT (D) and almost totally obstructing the tricuspid valve (E). (F) Cropped 3D transoesophageal echocardiography full-volume acquisition to show the tumor within the RA and through the TV. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2011. For permissions please email:
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