Intracardiac Tumors With Extracardiac Extension Diagnosed by Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration Terunaga Inage, MD,

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Intracardiac Tumors With Extracardiac Extension Diagnosed by Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration Terunaga Inage, MD, PhD, Takahiro Nakajima, MD, PhD, Yuki Sata, MD, Taiki Fujiwara, MD, PhD, Syunichiro Iwasawa, MD, PhD, Yuichi Takiguchi, MD, PhD, Yukio Nakatani, MD, PhD, Ichiro Yoshino, MD, PhD The Annals of Thoracic Surgery Volume 107, Issue 1, Pages e5-e7 (January 2019) DOI: 10.1016/j.athoracsur.2018.05.046 Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Imaging findings for patient 1. (A) Enhanced chest computed tomography shows a cardiac tumor arising from the left atrium (LA) wall into the right atrium (RA); the RA was almost obstructed by the tumor. (B) Positron emission tomography showed high levels of accumulation of 18F-fludeoxyglucose in the tumor (maximum standardized uptake value, 6.67). (C) Convex-probe ultrasound demonstrates the cardiac tumor and right atrial wall. Endoscopic elastography clearly delineates the border between the tumor and right atrial wall (arrows). (D) The endoscopic Doppler image demonstrates the blood flow within the RA. Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration was performed using a 22-gauge endobronchial ultrasound-guided transbronchial needle aspiration. (LV = left ventricle.) The Annals of Thoracic Surgery 2019 107, e5-e7DOI: (10.1016/j.athoracsur.2018.05.046) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Imaging findings for patient 2. (A) Transthoracic ultrasound revealed a large mass in the atrial septum (apical 4-chamber view). (B) Enhanced chest computed tomography revealed a cardiac tumor originating in the atrial septum and extending into both atria. (C) Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration was performed using a 19-gauge endobronchial ultrasound-guided transbronchial needle aspiration. (D) Fluoroscopy demonstrates the endoscopic ultrasound probe at the level of the atrium. (LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.) The Annals of Thoracic Surgery 2019 107, e5-e7DOI: (10.1016/j.athoracsur.2018.05.046) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

Supplemental Figure 1 The Annals of Thoracic Surgery 2019 107, e5-e7DOI: (10.1016/j.athoracsur.2018.05.046) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions