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An unusual cause of syncope
  1. P V Ennezat,
  2. J M Aubert,
  3. A Vincentelli,
  4. P Asseman
  1. ennezatyahoo.com

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A 65 year old man was admitted to our hospital for recurrent syncope. Two years before presentation, he had placement of a Le Veen shunt for an intractable ascite complicating liver cirrhosis. On physical examination he appeared well. His blood pressure was 130/80 mm Hg and heart rate was 85 beats/min. No sign of congestion or cardiac murmur was noticed and an ECG showed a normal sinus rhythm without abnormalities. Transthoracic echocardiogram detected a 3×8 cm floating fluid filled mass in the right atrium that prolapsed into the right ventricle at each cardiac cycle. Transoesophageal echocardiography indicated that the mass was an intracardiac pseudocyst and was attached to the venous tip of the shunt (panel A). Pulmonary perfusion lung scan did not reveal signs of pulmonary embolism. The patient underwent open heart surgery and the cavitary ascitic fluid filled mass was removed completely (panel B). Histologic examination confirmed that the wall of the pseudocyst comprised fibrin, red blood cells, mononuclear cells, and capillaries.


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Top: Transthoracic echocardiographic subcostal view showing a bilobal mass in the right atrium that appeared to be filled with fluid. Bottom: Transoesophageal echocardiographic view showing that the right atrial mass was attached to the venous tip of the peritoneal-venous shunt.


Embedded Image

Intraoperative view. The cavitary mass was filled with ascitic fluid provided by the shunt.

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