Less Invasive May Be Best: Diagnostic Implications Of a Transseptal Biopsy In a Young Male With a Left Atrial Mass
Aman Gupta, MD, The State University of New York at Buffalo, Buffalo, NY
Aman Gupta, MD, The State University of New York at Buffalo, Buffalo, NY
Title:
Less invasive may be best: Diagnostic implications of a trans-septal biopsy in a young male with a left atrial mass
Introduction:
Cardiac masses arise from various etiologies and rely heavily on surgically obtained specimen for definitive diagnosis, frequently obtained at the timed of surgical resection. Subjecting patients to surgical risk carry its own increased periprocedural mortality and morbidity. In some instances, it is prudent to have definitive diagnosis before subjecting patients to surgery. Herein, we describe a case percutaneous transseptal approach for diagnosis of a left atrial mass in a young patient.
Clinical Case:
A 34-year-old male with history of tobacco use presented to our tertiary center with complaints of dyspnea, hemoptysis and pleuritic chest discomfort. Vitals were notable for resting hypoxia and tachycardia. EKG demonstrated sinus tachycardia with diffuse non-specific T-wave abnormalities. CT Chest was notable for a filling defect in the left atrium with extension into the right superior and inferior pulmonary veins, and an associated right hilar mediastinal mass. Transesophageal echocardiography confirmed presence of left atrial mass. PET imaging revealed high metabolic activity with increased FDG uptake in the left atrial portion of the mass. Patient was sent for bronchoscopy/EBUS guided biopsy and a VATS biopsy which revealed necrotic tissue. Given patient’s young age and hesitancy to subject to surgical risk without a clear diagnosis, following a heart team discussion, a transseptal biopsy was performed to obtain a pathological specimen. Pathology was consistent with diffuse large B cell lymphoma. Patient is currently undergoing chemotherapy with intent to cure.
Discussion:
Percutaneous transcatheter transseptal approach is a safe and feasible technique for biopsy of cardiac masses in select patients and presents an alternative to conventional open surgical resection. This technique is especially helpful when surgical resection is deemed high risk and potentially non-curative or if patients may benefit from neoadjuvant/definitive chemotherapy or radiation therapy.