Inflammatory tumor of the myocardium--a case report
Liau, C.S.; Chiou, H.C.; Wang, T.C.; Liu, C.Z.; Lin, Y.M.; Hung, C.R.; Chen, C.M.
Journal of the Formosan Medical Association 79(11): 1057-1069
1980
ISSN/ISBN: 0371-7682 PMID: 6942099 Document Number: 159067
Myocardial tuberculosis is very rare and it is rarely successfully diagnosed. A case of myocardial inflammatory tumor is presented. It was regarded as tuberculous, was surgically treated and responded dramatically to anti-tuberculous regimens. The patient, a 24 yr old man, suffered from intermittent fever for 1 yr and typical angina pectoris for 4 mo. Chest roentgenograms revealed progressive enlargement of a left supracardiac mass. Cardiac catheterization demonstrated an infundibular pulmonary stenosis. Right ventriculograms showed a huge mass compressing the right ventricular outflow tract (RVOT) and proximal part of main pulmonary artery (MPA) from left and posterior aspects. At surgery a myocardial tumor was found at RVOT and MPA which extended posteriorly to involve the left atrium. Pathological examination revealed necrotizing inflammation and granulation tissue without evidence of neoplasm. The nature of this inflammatory tumor was considered most likely to be tuberculous. The patient had an excellent response to isoniazid, myambutol and rifampicin, showing a constant decrease of the supracardiac mass shadow on the follow-up roentgenograms. Prolonged fever and chest pain never recurred until a few days before death. Recatheterization 21 mo. after surgery showed no pressure gradient at RVOT and right ventriculograms revealed no compressing mass at RVOT and MPA. The patient died unexpectedly after several episodes of severe chest pain 22 mo. postoperatively. Some clinical and pathological aspects concerning myocardial tuberculosis were reviewed.