G Schaiberger1, D Pucar1, V Patel2, B Bateson3, H Williams1, W Bates1. 1. Department of Radiology, Augusta University Medical Center, 1120 15th St, Augusta, GA, 30912, USA. 2. Department of Cardiothoracic Surgery, Augusta University Medical Center, 1120 15th St, Augusta, GA, 30912, USA. 3. Department of Cardiothoracic Surgery, Augusta University Medical Center, 1120 15th St, Augusta, GA, 30912, USA. bbateson@augusta.edu.
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.
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.
Authors: Sunil M Prasad; Hersh S Maniar; Cindy J Camillo; Richard B Schuessler; John P Boineau; Thoralf M Sundt; James L Cox; Ralph J Damiano Journal: J Thorac Cardiovasc Surg Date: 2003-12 Impact factor: 5.209
Authors: J L Cox; R B Schuessler; H J D'Agostino; C M Stone; B C Chang; M E Cain; P B Corr; J P Boineau Journal: J Thorac Cardiovasc Surg Date: 1991-04 Impact factor: 5.209