Treatment Response can aid in Determining the Cause of Unusual Recurrent Intracardiac Masses

Diagnosing cardiac masses poses a significant clinical challenge in the pediatric population, particularly when accompanied by systemic symptoms. 

An otherwise healthy adolescent had multiple hospitalization episodes due to recurrent fevers, cachexia, and cardiac masses. Echocardiography and cardiac computed tomography initially suggested endocarditis, but the patient did not respond to antibiotic treatments. 

The patient developed recurrent cardiac masses in the right atrium and right ventricle that were debulked and biopsied. The histological assessment did not guide towards a conclusive diagnosis. 

Another hospitalization episode followed and was due to hemoptysis and large pulmonary pseudoaneurysms. They were occluded during cardiac catheterization. 

Moreover, the patient exhibited a spectrum of symptoms; of note, he showed improvement on steroids during surgical procedures. He was diagnosed with Hughes-Stovin syndrome––a variant of Behcet’s disease. 

The patient experienced complete symptom resolution with steroids and immunosuppression therapy. 

This case study highlighted the limitations of the standard diagnostic approach in detecting cardiac masses and the significance of treatment response in uncovering the underlying cause of unusual cardiac masses.

Source: Ro SS, Hashemi S, Shaw F, Slesnick T. Pediatrics. 2023 Nov 1;152(5).