Year: 2013
Type: article
Study design: Case Report
Abstract: A 44-year-old man presented to us with a history of chest discomfort since 3 days and pain and swelling of the left lower limb.There was no history of dyspnoea, palpitations or syncope.He was a smoker but not a diabetic or hypertensive.Cardiovascular examination was normal.ECG showed inverted T waves in lateral leads.An echocardiogram was performed which showed regional wall motion abnormality in the left anterior descending artery territory with good biventricular function.There was no evidence of pulmonary embolism.A large band-like structure with a fleshy calcific centre was noted in the left ventricular cavity.Troponin T levels were mildly elevated but all other blood investigations were normal.Venous Doppler showed evidence of deep vein thrombosis involving the left lower limb.He was taken up for a coronary angiogram in view of his ECG and echocardiogram findings.The angiogram did not reveal any significant coronary artery disease.However, fluoroscopy of the heart revealed the following interesting finding (videos 1 and 2; figure 1).A calcific ball-like structure was seen moving in the left ventricular (LV) cavity.The echocardiogram was repeated.In the midsegment of the LV cavity, a horizontal band (false tendon) was seen with a thick, calcific, ball-like central portion.There were no other mass lesions in the ventricle (video 3; figure 2).The septal and free wall attachments of the band were defined and it was confirmed to be a false tendon.The mass lesion had no direct attachment to any other part of the ventricle.The wall-motion abnormality persisted.There was no evidence of a patent foramen ovale on bubble contrast study.False tendons are band-like structures sometimes seen in the left ventricle.The incidence varies from 0.4% to 61% in various series. 1They usually extend from the interventricular septum to the free wall or rarely between two segments of the septum or from the papillary muscle to the septum.They are usually found at the level of the apical or midsegments of the left ventricular cavity. 2 They are usually thin, band-like structures but they may occasionally be thick and muscular.On the basis of histology, they can be classified into three typesfibrous, fibromuscular and muscular. 3The last two types tend to be thicker.False tendons are usually of no clinical significance but their presence may cause diagnostic confusions on the echocardiogram.In this case the false tendon was extremely thick Video 2 Fluoroscopy images (AP view) showing the ball like structure in the LV.Video 1 Cine angiography image(RAO view) showing the mobile ball like structure in the LV.
Source: BMJ Case Reports
Authors: Hashir Kareem, Tom Devasia
Institution: Kasturba Medical College Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2143100960