Para-atrial non-acute mediastinal hematoma after left atrial maze procedure mimicking tumor in a patient with treated melanoma

G. Schaiberger, Darko Pucar, Vijaykumar Surendrakant Patel, B. Bateson, Hadyn T Williams, William B Bates

Research output: Contribution to journalArticle

Abstract

Introduction: The Cox Maze III procedure is considered the gold standard open surgical procedure for management of atrial fibrillation. This article outlines a unique case of a para-atrial mediastinal hematoma following a bilateral thoracoscopic left atrial Maze procedure mimicking malignancy. Report: A 60-year-old male, with past history of melanoma, underwent bilateral thoracoscopic left atrial mini maze procedure with radiofrequency energy and exclusion of the left atrial appendage. Seven months later, a chest computed tomography (CT) scan was performed to evaluate for pulmonary embolism. The CT scan unexpectedly showed an ill-defined, heterogeneous para-atrial mass immediately superior to the left atrium concerning for tumor and mediastinal adenopathy. The mass was moderately hypermetabolic on subsequent 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) scan. A follow-up PET/CT three months later demonstrated near-complete resolution of the para-atrial mass with minimal residual hematoma. Conclusion: Non-acute mediastinal hematoma following a maze procedure can potentially be confused with a tumor mass and/or lymphadenopathy on CT and FDG PET/CT. With knowledge of the potential for false-positive FDG uptake in a hematoma, the lesion was monitored, and unnecessary biopsy was avoided.

Original languageEnglish (US)
Pages (from-to)1430-1432
Number of pages3
JournalJournal of Nuclear Cardiology
Volume25
Issue number4
DOIs
StatePublished - Aug 1 2018

Fingerprint

Hematoma
Melanoma
Fluorine
Tomography
Neoplasms
Glucose
Atrial Appendage
Heart Atria
Pulmonary Embolism
Positron-Emission Tomography
Atrial Fibrillation
Thorax
Biopsy
Lymphadenopathy
Positron Emission Tomography Computed Tomography

Keywords

  • Fluorine-18
  • PET imaging
  • PET/CT imaging
  • computed tomography (CT)
  • fluorodeoxyglucose (FDG)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Para-atrial non-acute mediastinal hematoma after left atrial maze procedure mimicking tumor in a patient with treated melanoma",
abstract = "Introduction: The Cox Maze III procedure is considered the gold standard open surgical procedure for management of atrial fibrillation. This article outlines a unique case of a para-atrial mediastinal hematoma following a bilateral thoracoscopic left atrial Maze procedure mimicking malignancy. Report: A 60-year-old male, with past history of melanoma, underwent bilateral thoracoscopic left atrial mini maze procedure with radiofrequency energy and exclusion of the left atrial appendage. Seven months later, a chest computed tomography (CT) scan was performed to evaluate for pulmonary embolism. The CT scan unexpectedly showed an ill-defined, heterogeneous para-atrial mass immediately superior to the left atrium concerning for tumor and mediastinal adenopathy. The mass was moderately hypermetabolic on subsequent 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) scan. A follow-up PET/CT three months later demonstrated near-complete resolution of the para-atrial mass with minimal residual hematoma. Conclusion: Non-acute mediastinal hematoma following a maze procedure can potentially be confused with a tumor mass and/or lymphadenopathy on CT and FDG PET/CT. With knowledge of the potential for false-positive FDG uptake in a hematoma, the lesion was monitored, and unnecessary biopsy was avoided.",
keywords = "Fluorine-18, PET imaging, PET/CT imaging, computed tomography (CT), fluorodeoxyglucose (FDG)",
author = "G. Schaiberger and Darko Pucar and Patel, {Vijaykumar Surendrakant} and B. Bateson and Williams, {Hadyn T} and Bates, {William B}",
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T1 - Para-atrial non-acute mediastinal hematoma after left atrial maze procedure mimicking tumor in a patient with treated melanoma

AU - Schaiberger, G.

AU - Pucar, Darko

AU - Patel, Vijaykumar Surendrakant

AU - Bateson, B.

AU - Williams, Hadyn T

AU - Bates, William B

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Introduction: The Cox Maze III procedure is considered the gold standard open surgical procedure for management of atrial fibrillation. This article outlines a unique case of a para-atrial mediastinal hematoma following a bilateral thoracoscopic left atrial Maze procedure mimicking malignancy. Report: A 60-year-old male, with past history of melanoma, underwent bilateral thoracoscopic left atrial mini maze procedure with radiofrequency energy and exclusion of the left atrial appendage. Seven months later, a chest computed tomography (CT) scan was performed to evaluate for pulmonary embolism. The CT scan unexpectedly showed an ill-defined, heterogeneous para-atrial mass immediately superior to the left atrium concerning for tumor and mediastinal adenopathy. The mass was moderately hypermetabolic on subsequent 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) scan. A follow-up PET/CT three months later demonstrated near-complete resolution of the para-atrial mass with minimal residual hematoma. Conclusion: Non-acute mediastinal hematoma following a maze procedure can potentially be confused with a tumor mass and/or lymphadenopathy on CT and FDG PET/CT. With knowledge of the potential for false-positive FDG uptake in a hematoma, the lesion was monitored, and unnecessary biopsy was avoided.

AB - Introduction: The Cox Maze III procedure is considered the gold standard open surgical procedure for management of atrial fibrillation. This article outlines a unique case of a para-atrial mediastinal hematoma following a bilateral thoracoscopic left atrial Maze procedure mimicking malignancy. Report: A 60-year-old male, with past history of melanoma, underwent bilateral thoracoscopic left atrial mini maze procedure with radiofrequency energy and exclusion of the left atrial appendage. Seven months later, a chest computed tomography (CT) scan was performed to evaluate for pulmonary embolism. The CT scan unexpectedly showed an ill-defined, heterogeneous para-atrial mass immediately superior to the left atrium concerning for tumor and mediastinal adenopathy. The mass was moderately hypermetabolic on subsequent 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) scan. A follow-up PET/CT three months later demonstrated near-complete resolution of the para-atrial mass with minimal residual hematoma. Conclusion: Non-acute mediastinal hematoma following a maze procedure can potentially be confused with a tumor mass and/or lymphadenopathy on CT and FDG PET/CT. With knowledge of the potential for false-positive FDG uptake in a hematoma, the lesion was monitored, and unnecessary biopsy was avoided.

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