Most intracardiac masses are tumors, and
90% are benign. Myxoma is the most common
intracardiac tumor in 70% of cases.[
5] Other possible
causes of intracardiac tumors include endocarditis,
fibroelastoma, cardiac metastasis, or vegetation in the
mitral valve.[
6]
Echocardiography is a reliable method for
the diagnosis of blood cysts. The appearance
of a hypoechoic cyst in the absence of signs of
systemic disease should raise suspicion for a blood
cyst. Transesophageal echocardiography is critical
in the differential diagnosis between cysts and thrombus. The demonstration of the intramural
contrast in contrast-enhanced echocardiography is
a pathognomonic sign of blood cysts.[7] Magnetic
resonance imaging has been shown to be superior
in the assessment of intracardiac masses and their
differential diagnosis, although histopathological
examination is currently the gold standard.[8]
Several theories have been proposed regarding the
formation of intracardiac blood cysts. These include
dilation of the vascular space, heteroplastic tissue
changes, inflammation, anoxia, and hemorrhagic
diathesis. The underlying mechanism of the formation
of intracardiac blood cysts is still unclear.[8] In rare
cases, a causal relationship cannot be established
between cyst formation and a known factor; however,
blood cyst formation secondary to a hematoma has
been reported in several cases with a history of cardiac
surgery.[9]
There is no consensus or any guidelines on
the optimal management of blood cysts. The vast
majority of patients with mitral blood cysts require
surgical resection.[10] Pelikan et al.[11] reported
that asymptomatic cysts could be monitored by
echocardiography due to their benign nature and that
resection should be reserved for patients with impaired
cardiac functions. Paşaoğlu et al.[12] recommended the
resection of cystic tumors of the heart, particularly
valvular cysts. However, surgical resection is usually
recommended for symptomatic patients,[1,13] large
tumors, valvular dysfunction,[14] or patients who are
asymptomatic, but would undergo open heart surgery
for other reasons.[15]
Khan et al.[2] also reported that as blood cysts
were associated with the intracardiac cavity, and
their rupture might cause systemic and coronary
embolization. They recommended that asymptomatic
small cysts should be monitored, while patients should
be administered anticoagulant therapy due to the risk
of thromboembolism.
In our patient, there were no other etiologies to
explain chest pain, and the cyst was associated with
the anterior mitral leaflet and protruded into the
left ventricular outflow tract in each systole, thereby,
creating a pressure gradient. Therefore, surgical
resection was decided. Surgery allows confirmation of
the diagnosis through the pathological examination,
and the elimination of malignancy. However, follow-up
with serial echocardiographic imaging may be a viable
option for asymptomatic or inoperable patients.
In conclusion, although rare, blood cysts should be
considered in the differential diagnosis of hypoechoic
masses as evidenced by echocardiography. There are
no available data on the long-term follow-up of
patients with intracardiac blood cysts. The cysts can
be fully surgically resected. If a valvular defect or a
disruption of valvular coaptation occur after surgical
excision, it should be corrected simultaneously.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect
to the authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.
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