Percutaneous left atrial cardiac biopsy under multidectector computed tomography guidance

Abstract

We appreciated the paper of Yuce et al. (1) entitled “An unusual case of cardiac lymphoma diagnosed using computed tomography-guided percutaneous transthoracic biopsy.” The authors clearly highlighted several techniques to obtain a biopsy specimen from a cardiac mass. Very few studies have been conducted using this technique in literature (1). We report a case of left atrial cardiac mass, where percutaneous biopsy under multidectector computed tomography (MDCT) guidance was decisive for the diagnosis and consequently for the type of treatment. A 78-year-old man was evaluated in our hospital for cardiac congestion and had lost weight over the past 6 months. Thoracoabdominal MDCT showed a cardiac mass at the posterior wall of the left atrium, with suspected left pulmonary hilum infiltration (Fig. 1a). Transbronchial biopsy at the left pulmonary hilum gave a negative result for cancer cells. After multidisciplinary discussions, the patient was a candidate for percutaneous approach biopsy. Under MDCT guidance, with the patient in prone position, a dorsal intercostal percutaneous transpulmonary access was done for biopsy of the left atrial cardiac mass (Fig. 1b). MDCT post-procedural control demonstrated absence of cardiac, mediastinal, and lung complications (Fig.1c, 1d). Histopathological evaluation demonstrated an undifferentiated high-grade intimal sarcoma with a proliferative index (Ki67) of 25%. On immunohistochemical examination, tumor