Blood Cysts and Echocardiography

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Blood cyst on the tricuspid valve (arrow). Photo courtesy of the Armed Forces Institute of Pathology.

Intracardiac blood cysts were first reported by Elsässer in 1844 and later by Luschka in 1857.

They are congenital, located on the endocardium, particularly along the lines of closure of heart valves. The cysts are thin walled, lined by flattened, cobblestone shaped, endothelium and filled with non-organized blood.

They are considered diverticula that result from microscopic invaginations of atrial endothelium into atrioventricular valves, and rarely of ventricular endothelium into semilunar valves.

They are incidentally found during autopsy on cardiac valves in approximately 50 percent of infants under 2 months of age. They are rarely found on autopsy after two years of age.

They are multiple in over 50 percent of autopsy cases. Up to 20 coexisting cysts have been reported. They usually affect the atrioventricular valves. The semilunar valves are infrequently involved.

The usual size ranges from microscopic to 3 mm in diameter. Occasionally blood cysts are much larger, making them more likely to be detected by echocardiography.

In these rare cases where unsuspected cysts are found during an echocardiographic study, their hemodynamic impact, if any, should be determined by Doppler techniques. They should be monitored with serial echocardiographic studies. Beacuse of their typically benign nature, surgical resection should be reserved for those cystic masses that interfere with normal cardiac function.

References

  1. Elsässer C. Bericht über die Ereignisse in der Gebäranstalt des Catherinen-Hospital im Jahre 1844. Med Correspondenzblatt 1844;14:297.
  2. Luschka H. Die Blutergüsse im Gewebe der Herzklappen. Virchows Arch Pathol Anat 1858;11:144-9.
  3. Burke A, Virmani R. Tumors of the heart and great vessels. Atlas of Tumor Pathology, 3rd Series, Fascicle 16. Washington, D.C. Armed Forces Institute of Pathology, 1996. pp.79-80.
  4. Mohanty SR, Murthy KS, Krishnanaik S, Sivaraman A, Cherian KM. Cardiac blood-filled cyst at the atrialized portion of the right ventricle in a patient with Ebstein anomaly: a case report. J Thorac Cardiovasc Surg. 2000 Aug;120(2):422-3.
  5. Pelikan HM, Tsang TS, Seward JB. Giant blood cyst of the mitral valve. J Am Soc Echocardiogr. 1999 Nov;12(11):1005-7.
  6. Boyd WC, Hartman GS, Reilly DM, Kreiger KH. An adult atrial blood cyst. J Cardiothorac Vasc Anesth. 1999 Oct;13(5):592-3.
  7. Minato H, Manabe T, Masaki H, Kawahara Y. Blood cyst of the pulmonary valve in an adult: report of a case and review of the literature. Hum Pathol 1997;28:252-5.
  8. Niinami H, Ishihara S, Hara S, Tanaka S, Yamaguti E, Takase S. Blood cyst with a calcium stone originating from the right atrial septum. Cardiovasc Surg 1996;4:260-2.
  9. Boyd TAB. Blood cysts on heart valves of infants. Am J Pathol 1949;25:757-9.
  10. Levinson SA, Learner A. Blood cysts on heart valves of new-born infants. Arch Pathol 1932;14:810-7.
  11. Pasaoglu I, Dogan R, Nazli N, Gungen Y, Bozer AY. Blood cyst originating from tricuspid septal leaflet. J Cardiovasc Surg (Torino) 1991;32:589-91.
  12. Pasaoglu I, Dogan R, Demircin M, Bozer AY. Blood cyst of the pulmonary valve causing pulmonic valve stenosis. Am J Cardiol 1993;72:493-4.
  13. Zimmerman KG, Paplanus SH, Dong S, Nagle RB. Congenital blood cysts of the heart valves. Hum Pathol 1983;14:699-703.
  14. Xie SW, Lu OL, Picard MH. Blood cyst of the mitral valve: detection by transthoracic and transesophageal echocardiography. J Am Soc Echocardiogr 1992;5:547-50.
  15. Arnold IR, Hubner PJ, Firmin RK. Blood filled cyst of the papillary muscle of the mitral valve producing severe left ventricular outflow tract obstruction. Br Heart J 1990;63:132-3.
  16. Kantelip B, Satge D, Camilleri L, Chenard MP, De Riberolles C. Valvular cyst and atrioventricular canal in a child with trisomy 21. Ann Pathol 1994;14:101-7.
  17. Roberts PF, Serra AJ, McNicholas KW, Shapira N, Lemole GM. Atrial blood cyst: a rare finding. Ann Thorac Surg 1996;62:880-2.
  18. Sim EK, Wong ML, Tan KT, Sim SK. Blood cyst of the tricuspid valve. Ann Thorac Surg 1996;61:1012-3.

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