Blood Cysts and Echocardiography
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
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.
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February 23, 2007.