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Acute Myocardial Infarction, Pulmonary Embolism, and a Suspicious Aortic Mass: A Case of Complex Differential Diagnosis and Management

Mihai Teodor Bica
Mihai Teodor Bica
, 
Claudia Irina Nitu
Claudia Irina Nitu
, 
Andrei Iosifescu
Andrei Iosifescu
, 
Carmen Cristiana Beladan
Carmen Cristiana Beladan
 y 
Bogdan A. Popescu
Bogdan A. Popescu
   | 30 jun 2023
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Article Category: Case Report
Publicado en línea: 30 jun 2023
Páginas: 78 - 82
DOI: https://doi.org/10.2478/rjc-2023-0013
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© 2023 Mihai Teodor Bica et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

ECG trace: sinus rhythm, mild ST elevation, and inverted T waves in DI, aVL, V2-V6 and Q wave in DI, aVL, V4-V6.
ECG trace: sinus rhythm, mild ST elevation, and inverted T waves in DI, aVL, V2-V6 and Q wave in DI, aVL, V4-V6.

Figure 2

2D transthoracic echocardiography – parasternal long axis view. A mobile, irregular mass (arrow), 21/11 mm, attached to the aortic root wall at the level of the left sinus of Valsalva with no impact on the aortic valve.
2D transthoracic echocardiography – parasternal long axis view. A mobile, irregular mass (arrow), 21/11 mm, attached to the aortic root wall at the level of the left sinus of Valsalva with no impact on the aortic valve.

Figure 3

2D transesophageal echocardiography – mid-esophageal short axis view. The presence of a mobile mass (arrow), irregular, apparently with a pediculated insertion point near the commissure between the aortic noncoronary and left coronary cusps is confirmed.
2D transesophageal echocardiography – mid-esophageal short axis view. The presence of a mobile mass (arrow), irregular, apparently with a pediculated insertion point near the commissure between the aortic noncoronary and left coronary cusps is confirmed.

Figure 4A

Thoracic computed tomography – axial plane. The mural irregular mass (arrow) is located in the aortic root at the left sinus of Valsalva level, in the proximity of the left main ostium. *Courtesy of Dr. Dragoş Caravasile
Thoracic computed tomography – axial plane. The mural irregular mass (arrow) is located in the aortic root at the left sinus of Valsalva level, in the proximity of the left main ostium. *Courtesy of Dr. Dragoş Caravasile

Figure 4B

Thoracic computed tomography – axial plane. The proximity of the aortic mass (arrow) with the left main ostium is revealed. *Courtesy of Dr. Dragoş Caravasile
Thoracic computed tomography – axial plane. The proximity of the aortic mass (arrow) with the left main ostium is revealed. *Courtesy of Dr. Dragoş Caravasile

Figure 5

Intraoperative image – median sternotomy. The aortotomy allows visualization of the aortic mass (asterisk): multilobed, friable, attached on the aortic wall through a pediculated insertion point near the commissure between noncoronary cusp and left coronary cusp.
Intraoperative image – median sternotomy. The aortotomy allows visualization of the aortic mass (asterisk): multilobed, friable, attached on the aortic wall through a pediculated insertion point near the commissure between noncoronary cusp and left coronary cusp.

Figure 6

Histopathological examination of the mass. Hematoxylin eosin coloration reveals organized thrombus mainly composed of fibrin and platelet cells. *Courtesy of Dr. Liliana Parascan
Histopathological examination of the mass. Hematoxylin eosin coloration reveals organized thrombus mainly composed of fibrin and platelet cells. *Courtesy of Dr. Liliana Parascan

Figure 7A

Postoperative 2D-transthoracic echocardiography. Parasternal long axis view confirms the absence of the previously described mass, with normal function of the aortic valve.
Postoperative 2D-transthoracic echocardiography. Parasternal long axis view confirms the absence of the previously described mass, with normal function of the aortic valve.

Figure 7B

Postoperative 2D-transthoracic echocardiography. Parasternal short axis view confirms successful aortic thrombus resection with preserved integrity of the aortic valve and wall.
Postoperative 2D-transthoracic echocardiography. Parasternal short axis view confirms successful aortic thrombus resection with preserved integrity of the aortic valve and wall.
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Medicine, Clinical Medicine, Internal Medicine, Cardiology, Pediatrics and Juvenile Medicine, Paediatric Cardiology, Surgery, Cardiac Surgery
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