Abstract: HomeCirculationVol. 116, No. 1An Unusual Site for a Common Disease Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBAn Unusual Site for a Common Disease Maysaa Alzetani, MRCP, MSc, Joseph J. Boyle, MRCP, PhD, David Lefroy, MA, MB, BChir, FRCP and Petros Nihoyannopoulos, MD, FRCP Maysaa AlzetaniMaysaa Alzetani From the Hammersmith Hospital NHS Trust (M.A.), and the Histopathology Department (J.J.B.) and Hammersmith Hospital (D.L., P.N.), Imperial College, London, UK. , Joseph J. BoyleJoseph J. Boyle From the Hammersmith Hospital NHS Trust (M.A.), and the Histopathology Department (J.J.B.) and Hammersmith Hospital (D.L., P.N.), Imperial College, London, UK. , David LefroyDavid Lefroy From the Hammersmith Hospital NHS Trust (M.A.), and the Histopathology Department (J.J.B.) and Hammersmith Hospital (D.L., P.N.), Imperial College, London, UK. and Petros NihoyannopoulosPetros Nihoyannopoulos From the Hammersmith Hospital NHS Trust (M.A.), and the Histopathology Department (J.J.B.) and Hammersmith Hospital (D.L., P.N.), Imperial College, London, UK. Originally published3 Jul 2007https://doi.org/10.1161/CIRCULATIONAHA.106.677120Circulation. 2007;116:e1A 75-year-old Asian woman presented with a 5-month history of night sweats, lethargy, and malaise. On admission she was found to have low-grade pyrexia and elevated inflammatory markers. Septic screen, which included repeated blood cultures and chest x-ray (Figure 1), were negative. A transthoracic and transesophageal echocardiography revealed a doughnut-shaped mass (online Data Supplement Movie I) that surrounded the mitral valve annulus and extended up to the left atrial walls and atrial septum. A surgical biopsy was taken (Figure 2), which showed epithelioid and langhans giant cell granulomas with central caseating necrosis consistent with tuberculosis. Special staining with high-sensitivity immunoperoxidase confirmed the diagnosis of tuberculosis. The patient was treated for tuberculosis with complete resolution of her symptoms. Repeated echocardiography 6 months later showed a dramatic reduction of the mass size (Data Supplement Movies II and III). Download figureDownload PowerPointFigure 1. Posterior-anterior chest x-ray, taken on admission, shows clear lung fields and no signs of infection.Download figureDownload PowerPointFigure 2. Biopsy taken from the mass that surrounded the mitral valve annulus and extended up to the left atrial walls and atrial septum. Hematoxylin and eosin staining. Magnification, ×20. Ep indicates epithelioid macrophages; L, Langhans giant cells; and N, necrosis. Inset, immunohistochemistry with monoclonal antibody to mycobacterium (Dako, Glostrup, Denmark) and immunoperoxidase (Menarini Diagnostic, Wokingham, UK). B indicates bacillus; M, macrophage. Magnification, ×100 (cropped for space).Isolated cardiac tuberculosis is extremely rare. However it should be included in the differential diagnosis of intracardiac masses.The online-only Data Supplement, consisting of movies, is available with this article at http://circ.ahajournals.org/cgi/content/full/116/1/e1/DC1.Sources of FundingDr Boyle has received research support from the British Heart Foundation, KRUK, HHRTC, and the Broad Foundation.DisclosuresDr Boyle has received honoraria from the International Journal of Experimental Pathology, has served as a speaker for the Histochemical Society and the British Atherosclerosis Society as a member of the editorial board for the International Journal of Experimental Pathology, and as an expert witness to UK coroners and mesothelioma panels.FootnotesCorrespondence to Dr Maysaa Alzetani, 42 Tryfan Close, Ilford, London IG4 5JY, United Kingdom. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Kemaloğlu Öz T, Elsayed M, Nanda N, Kalenderoğlu K, Akyüz Ş, Atasoy I, Ösken A, Onuk T and Eren M (2016) Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of a tuberculoma involving the left atrium and appendage, Echocardiography, 10.1111/echo.13320, 33:9, (1409-1412), Online publication date: 1-Sep-2016. July 3, 2007Vol 116, Issue 1 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.677120PMID: 17606848 Originally publishedJuly 3, 2007 PDF download Advertisement SubjectsDiagnostic TestingEchocardiographyEtiologyInfectious Endocarditis