This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Daniels, C. J. Articles by Rowland, D. G. Search for Related Content PubMed Articles by Daniels, C. J. Articles by Rowland, D. G.

(Circulation. 1999;99:e1-e2.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Prenatal Detection of a Pericardial Teratoma

Curt J. Daniels, MD; Daniel M. Cohen, MD; John R. Phillips, MD; Daniel G. Rowland, MD

From the Divisions of Pediatric Cardiology and Cardiothoracic Surgery, The Ohio State University, Children's Hospital, Columbus, Ohio.

Correspondence to Curt J. Daniels, MD, Columbus Children's Hospital, Division of Cardiology, 700 Children's Dr, Columbus, OH 43205. E-mail cdaniels{at}chi.osu.edu

A17-year-old gravida II, para I woman was referred for a fetal echocardiographic evaluation at 28 weeks of gestation because of the finding of hydrops fetalis on an obstetrical scan. The study demonstrated a large, complex, anterior mediastinal mass resulting in rotation of the heart leftward and posterior with compression of the right heart chambers (Figure 1). The intracardiac anatomy was normal, with no significant inflow or outflow obstruction identified. Intrauterine removal of the mass was considered but declined by the parents. Preterm labor developed at 32 weeks of gestation and was unresponsive to medical management. The infant was delivered by cesarean section and required immediate endotracheal intubation for respiratory distress. The infant developed hypotension responsive to volume resuscitation and vasopressor medications. The infant's respiratory status stabilized with high-frequency ventilation.

View larger version (89K): [in this window] [in a new window]   Figure 1. Fetal echocardiogram at 28 weeks of gestation demonstrating a large anterior mediastinal mass. Mass was inhomogeneous, with solid and cystic areas consistent with a teratoma (T). Arrows outline extent of tumor. Right ventricle (RV) was mildly compressed. Left ventricle (LV) appeared normal. A indicates anterior; P, posterior; R, right; and L, left.

An MRI was obtained to evaluate the mass and its extent within the thoracic cavity before surgical intervention. The MRI confirmed the diagnosis of a large anterior mediastinal mass consistent with a pericardial teratoma (Figure 2).

View larger version (121K): [in this window] [in a new window]   Figure 2. Thoracic MRI. T1-weighted parasagittal image demonstrating an anteriorly located mass measuring 7 cm in transversex5 cm superior to inferiorx4.5 cm anterior (A) to posterior (P). Mass has solid and cystic components with multiple septations. Border of mass could not be distinguished from cardiac structures. Arrows outline posterior aspect of tumor.

On the fourth day of life, the child was taken to the operating room. The tumor was exposed through a median sternotomy incision. As noted on the fetal echocardiogram and MRI, the mass occupied the majority of the anterior mediastinal space and displaced the heart leftward and posterior. The mass arose from the ascending aorta. Manipulation of the tumor resulted in aortic obstruction and profound hypotension. The size of the tumor precluded initiation of cardiopulmonary bypass. The tumor was excised at its base, leaving a large defect in the aortic wall. The patient was placed on cardiopulmonary bypass, and the aorta was reconstructed with a patch of cryopreserved pulmonary homograft.

Pathological study of the tumor confirmed the diagnosis of teratoma with immature complex elements (Figure 3).

View larger version (44K): [in this window] [in a new window]   Figure 3. Gross pathological specimen. Arrow defines attachment to ascending aorta. Mass measured 7.5x5.0x4.0 cm. Serial sectioning demonstrated mass to be 80% solid and 20% cystic. Microscopic examination confirmed diagnosis of pericardial teratoma with 15% immature neural tissue.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Daniels, C. J. Articles by Rowland, D. G. Search for Related Content PubMed Articles by Daniels, C. J. Articles by Rowland, D. G.