Ann Thorac Surg 2003;76:626
© 2003 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Intrapericardial teratoma in a neonate
Subash C. Reddy, MD*a,
Kathleen M. Fenton, MDa,
Sanjiv K. Gandhi, MDa,
Lizabeth M. Lanford, MDa,
Frank A. Pigula, MDa
a Division of Pediatric Cardiology and Cardiothoracic Surgery, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
* Address reprint requests to Dr Reddy, Division of Pediatric Cardiology, Children’s Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213-2583, USA
e-mail: reddsc{at}chp.edu
A male child was born at term to a 29-year-old mother, whose antenatal course was complicated by poyhydramnios and a large mediastinal mass in the fetus. This newborn had an uneventful delivery and was stable from a cardiorespiratory standpoint. On cardiovascular examination, he had normal heart sounds and no murmurs. His chest roentgenogram showed a cardiothoracic ratio of 0.85. Echo-Doppler and cardiac magnetic resonance imaging studies with T1-weighted images in coronal, sagittal, axial, and two-chamber fast cine planes, and post-contrast images in a few selective planes were performed. This imaging demonstrated a well-encapsulated, multicystic, and heterogeneous intrapericardial mass lesion attached to the base of the heart with compression of the atria and moderate pericardial effusion (Fig A).
At operation, the pericardium was opened to reveal an encapsulated mass lesion measuring 6 x 5 x 5 cm. The mass was on the right side of the heart, displacing the heart into the left chest. The superior portion was densely adherent to the ascending aorta and to the right pulmonary artery. This mass occupied a major portion of the pericardial space and was displacing the heart towards the left, as shown in the intraoperative photograph (Fig B). This extruding mass (Fig C) was completely resected employing a brief period of cardiopulmonary bypass to repair the aorta after the tumor resection. The baby had an uneventful postoperative course and was discharged home 5 days later.
On gross pathologic examination, the outer surface of the tumor was red-tan and weighed 56 g. The cut sections of the tumor revealed cystic and solid areas. Histopathological examination confirmed an immature teratoma.
Intrapericardial teratoma is the fourth most common cardiac tumor and is often diagnosed in utero, in the newborn period, and during infancy. These are attached to the base of the heart, typically to the aorta or the pulmonary artery, and cause extrinsic cardiac compression. The majority of these tumors are benign and are resectable by surgery. Our case exemplifies all the typical features of an intrapericardial teratoma.Fig. 1
