Lots of interesting abstracts and cases were submitted for TCTAP 2024. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-213
An Interesting Case Report: Acute Myocardial Infarction Which Doesn’t End up in Cardiac Catheterization Laboratory
By Chatchai Pitakrattanachai, Wittawat Wattanasiriporn
Presenter
Chatchai Pitakrattanachai
Authors
Chatchai Pitakrattanachai1, Wittawat Wattanasiriporn1
Affiliation
Rajavithi Hospital, Thailand1,
View Study Report
TCTAP C-213
Structural - Imaging - Echocardiography
An Interesting Case Report: Acute Myocardial Infarction Which Doesn’t End up in Cardiac Catheterization Laboratory
Chatchai Pitakrattanachai1, Wittawat Wattanasiriporn1
Rajavithi Hospital, Thailand1,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
A 69 year-old Thai woman with unknown underlying condition. Presented with chronic dyspnea, orthopnea and chest discomfort for 1 week prior to admission. Upon admission day, she was good consciousness with stable vital signs and afebrile. None of chest deformities were seen. Cardiovascular examinations are unremarkable, without jugular venous distension or murmur and gallops. Pulmonary examinations revealed tachypnea and fine crepitation of bilateral lower lung fields.
Relevant Test Results Prior to Catheterization
Electrocardiogram (ECG) was performed-showing sinus rhythm 110 beats per min (BPM) with ST-segment depression in leads I, II, aVL and V4-V6, with chest radiograph (CXR) showed cardiomegaly with bilateral pulmonary congestion. High sensitivity troponin-I (hs-TropI) and N-terminal pro B-type natriuretic peptide (NT-pro BNP) were requested with highly elevated result as 2261.9 ng/L, 7270 pg/mL respectively. Acute NSTE-ACS with congestive heart failure was diagnosed.
Relevant Catheterization Findings
Echocardiogram accidentally found large anterior heterogeneous mass sized about 5x7 cm. This mass adjacent to right atrium (RA), right ventricle (RV) and tricuspid annulus causing mild to moderate tricuspid regurgitation (TR), no pericardial effusion. Chest CT was requested, reporting irregular-shaped heterogeneous anterior mediastinal mass sized 6.7x9x4.7 cm involving tricuspid valve, anterior wall of RA and RV. Right coronary artery (RCA) also passed through this mass.
Interventional Management
Procedural Step
This mass was suspected to be malignancy then bronchoscopy with lymph node biopsy and bone marrow biopsy were done. Bronchoscopy with mediastinal lymph node biopsy were done. Lymph node tissue histopathology reported malignant small round cell tumor with positive for CD20, CD45, BCL-6 and C-MYC immunohistochemistry, suggestive of diffused large B-cell lymphoma. Finally, bone marrow tissue biopsy was done and histopathology reported hypercellularity involved by high-graded mature B-cell lymphoma leading to diagnosis of Non-Hogkin's lymphoma stage IV and promptly CHOP regimen chemotherapy treatment.
Case Summary
This paper reported a rare challenging case presentation of acute NSTE-ACS with congestive heart failure which may confuse diagnosis of atherosclerotic heart disease as main underlying condition which may needed for urgently coronary angiography and intervention in general circumstance. But with carefully investigation, echocardiogram finding revealed an large anterior mediastinal mass which invading myocardium and coronary artery and leading to diagnosis of B-cell lymphoma.