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Cardiac Septal Aneurysm Mimicking Pseudomass: Appearance on ECG-Gated Cardiac MRI and MDCT

Jonathan D. Dodd1,2, Suzanne L. Aquino1, Godtfred Holmvang3, Ricardo C. Cury1,2, Udo Hoffmann1,2, Thomas J. Brady1,2 and Suhny Abbara1,2

1 Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., Boston, MA 02114.
2 Cardiac CT/MRI/PET Program, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
3 Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.


Figure 1
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  		Fig. 1A —88-year-old man with history of penile carcinoma. See also Figure S1C, cine loop, in supplemental data. Nongated routine contrast-enhanced axial chest CT scan shows smooth mass (arrow) suspected of being left atrial tumor.

 

Figure 2
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  		Fig. 1B —88-year-old man with history of penile carcinoma. See also Figure S1C, cine loop, in supplemental data. Cardiac bright-blood steady-state free precession MR image in four-chamber view shows thin membrane (arrow) consistent with interatrial septal aneurysm filled with nonopacified blood and corresponding exactly to pseudomass seen on nongated chest CT.

 

Figure 3
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  		Fig. 2A —74-year-old man with bladder cancer. See also Figure S2C, cine loop, in supplemental data. Staging nongated contrast-enhanced chest CT scan shows mass (arrow) suspected of being tumor in left atrium.

 

Figure 4
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  		Fig. 2B —74-year-old man with bladder cancer. See also Figure S2C, cine loop, in supplemental data. Cardiac MR image obtained with steady-state free precession sequences shows thin membrane (arrow) consistent with interatrial septum filled with blood and bowing 12 mm into left atrium.

 

Figure 5
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  		Fig. 3A —57-year-old man with squamous cell carcinoma of skin secondary to immunosuppressive therapy. See also Figure S3D, cine loop, in supplemental data. Double-inversion T1-weighted fast spin-echo short-axis MR image shows apparent high-signal-intensity nodular mass (arrow) arising from region of tricuspid annulus.

 

Figure 6
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  		Fig. 3B —57-year-old man with squamous cell carcinoma of skin secondary to immunosuppressive therapy. See also Figure S3D, cine loop, in supplemental data. Proton-density fast spin-echo four-chamber MR image shows apparent mass (arrow) in region of tricuspid annulus. Slight blurring of heart borders is evident with motion artifact secondary to suboptimal gating.

 

Figure 7
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  		Fig. 3C —57-year-old man with squamous cell carcinoma of skin secondary to immunosuppressive therapy. See also Figure S3D, cine loop, in supplemental data. Cardiac-gated MDCT scan shows membranous interventricular septal aneurysm (arrow) protruding 15 mm into right ventricular outflow tract. Finding was confirmed on transthoracic echocardiography.

 

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