From the Divisions of Cardiology (M.B.) and Cardiovascular Surgery
(I.M.R.) and the Department of Diagnostic Imaging (M.P., J.M.), The Hospital
for Sick Children, University of Toronto, Canada.
Correspondence to Dr John Mawson, Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
A 1-month-old boy presented with signs of heart
failure and tamponade. Two-dimensional
echocardiography revealed a complex mass with a
large pericardial effusion compressing the heart. Magnetic resonance
imaging (Fig 1
Intrapericardial teratomas are rare primary cardiac tumors usually
diagnosed in neonates and infants.1 2 They
contain endodermic, mesodermic, and neuroectodermic germinal
layers.3 Intrapericardial teratomas are usually
benign tumors but may be life-threatening because of large pericardial
effusion and cardiac compression.1 2
Echocardiography generally suggests the diagnosis
by showing a heterogeneous intrapericardial mass associated
with a pericardial effusion compressing the
heart.2
Two-dimensional echocardiography is considered to
be the best diagnostic imaging modality for primary cardiac
tumors, but magnetic resonance imaging may have advantages with large
tumors in defining the relationship of the tumor to adjacent
structures, in visualizing echocardiographic
"blind" spots, and in defining tissue characteristics.
Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
References
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine
Intrapericardial Teratoma
) defined the relationship
of the mass to the pericardium, myocardium, and great
vessels. Complete surgical resection was performed without complication
(Fig 2). Histology of the mass confirmed
the presumptive imaging diagnosis of teratoma. The patient remains free
of symptoms and tumor 1 year after surgery.
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Figure 1. Magnetic resonance imaging. Axial T1-weighted
spin-echo images. A, Main tumor mass (*) is seen displacing mediastinal
structures. Thymus (THYM) is displaced rightward and superiorly (not
shown), while aorta (AO) and main pulmonary artery (MPA) are
displaced posteriorly and splayed. B, Intrapericardial nature of the
tumor is demonstrated on a lower image, with tongues of tumor (*)
projecting into pericardial space, indenting right atrium (RA).
There is an effusion (Eff) and pericardial thickening (arrowheads). LA
indicates left atrium.
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Figure 2. Gross specimens following surgical
resection. A, Tumor bulk is clearly seen, as are two tumor tongues
(*) identified in Fig 1B 
. B, On cut section, cystic and solid
nature of lesion is demonstrated, correlating well with variations in
signal intensity seen in main tumor mass in Fig 1A.
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