Abstract
Cardiac masses may present themselves upon investigation of cardiovascular symptoms, systemic manifestations, or incidentally upon screening. The differential diagnosis, workup, and subsequent management are heavily dependent upon the presenting clinical setting and the individual patient. In the broadest terms, a mass may be a benign or malignant tumor, a degenerative or infectious process, a normal but prominent structure, or even merely an imaging artifact that has been misinterpreted.
Armed with a basic knowledge of the most common entities and the demographic in which they typically present, together with an awareness of the pathways in which cancer or masses can involve the heart, one may then choose the most appropriate cardiac imaging modality and workup to diagnose and treat the patient.
In this chapter, the most common masses affecting the heart are presented with updated strategies for further refining the differential diagnosis. Initial treatment strategies and recommendations based on the available literature are presented.
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References
Butany J, Leong SW, Carmichael K, Komeda M. A 30-year analysis of cardiac neoplasms at autopsy. Can J Cardiol. 2005;21(8):675–80.
McAllister Jr HA, Fenoglio Jr JJ. Tumors of the cardiovascular system. In: Atlas of tumor pathology, Fascicle 15, vol. 2. Washington, DC: Armed Forces Institute of Pathology; 1978.
Burke A, Virmani R. Tumors of the heart and great vessels. In: Atlas of tumor pathology, Fascicle 16, vol. 3. Washington, DC: Armed Forces Institute of Pathology; 1996.
Lam KY, Dickens P, Chanc AC. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med. 1993;117:1027–31.
Silvestri F, Bussani R, Pavletic N, Mannone T. Metastases of the heart and pericardium. G Ital Cardiol. 1997;27:1252.
Douglas PS, Garcia MJ, Haines DE, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. J Am Coll Cardiol. 2011;57:1126–66.
Chahinian AP, Gutstein DE, Fuster V. Tumors of the heart and great vessels. In: Bast Jr RC, Kufe DW, Pollock RE, et al., editors. Holland-Frei cancer medicine. 5th ed. Hamilton: BC Decker; 2000. Chapter 91.
Elbardissi AW, Dearani JA, Daly RC, et al. Embolic potential of cardiac tumors and outcome after resection: a case-control study. Stroke. 2009;40:156–62.
Sun JP, Asher C, Yang XS, Cheng G, Scalia GM, Massed AG, et al. Clinical and echocardiographic characteristics of papillary fibroelastomas: a retrospective and prospective study in 162 patients. Circulation. 2001;103:2687–701.
Oliveira R, Branco L, Galrinho A, et al. Cardiac myxoma: a 13-year experience in echocardiographic diagnosis. Rev Port Cardiol. 2010;29:1087–100.
Peters PJ, Reinhardt S. The echocardiographic evaluation of intracardiac masses: a review. J Am Soc Echocardiogr. 2006;19:230–40.
Reynen K. Cardiac myxomas. N Engl J Med. 1995;333:1610–7.
ElBardissi AW, Dearani JA, Daly RC, et al. Analysis of benign ventricular tumors: long-term outcome after resection. J Thorac Cardiovasc Surg. 2008;135:1061–8.
Gowda RM, Khan IA, Nair CK, et al. Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J. 2003;146:404–10.
Abraham KP, Reddy V, Gattuso P. Neoplasms metastatic to the heart: review of 3314 consecutive autopsies. Am J Cardiovasc Pathol. 2009;3:195–8.
Gibs P, Cebon JS, Calafiore P, Robinson WQ. Cardiac metastases from malignant melanoma. Cancer. 1999;85:78–84.
Butany J, Nair V, Naseemuddin A, et al. Cardiac tumours: diagnosis and management. Lancet Oncol. 2005;6:219–28.
Carney JA. Differences between nonfamilial and familial cardiac myxoma. Am J Surg Pathol. 1985;9:53–5.
Zeebregts CJ, Hensens AG, Timmermans J, Pruszczynski MS, Lacquet LK. Lipomatous hypertrophy of the interatrial septum: indication for surgery? Eur J Cardiothorac Surg. 1997;11:785–7.
Maisch B, et al. The task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology. Guidelines on the diagnosis and management of pericardial diseases executive summary. Eur Heart J. 2004;25:587–610.
Satur CMR, Hsin MKY, Dussek JE. Giant pericardial cysts. Ann Thorac Surg. 1996;61:208–10.
Patel J, Park C, Michaels J, Rosen S, Kort S. Pericardial cyst: case reports and a literature review. Echocardiography. 2004;21:269–72.
Shiraishi I, Yamagishi M, Kawakita A, Yamamoto Y, Hamaoka K. Acute cardiac tamponade caused by massive hemorrhage from pericardial cyst. Circulation. 2000;101:E196–7.
Beghetti M, Gow RM, Haney I, et al. Pediatric primary benign cardiac tumors: a 15-year review. Am Heart J. 1997;134:1107–14.
Parmley LF, Salley RK, Williams JP, Head 3rd GB. The clinical spectrum of cardiac fibroma with diagnostic and surgical considerations: noninvasive imaging enhances management. Ann Thorac Surg. 1988;45:455–65.
Roberts WC. Primary and secondary neoplasms of the heart. Am J Cardiol. 1997;80:671–82.
Gaspar A, Salome N, Nabais S, et al. Echocardiographic assessment of a cardiac lymphoma: beyond two-dimensional imaging. Eur J Cardiovasc Imaging. 2009;10:975–8.
Kirkpatrick JN, Wong T, Bednarz JE, et al. Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. J Am Coll Cardiol. 2004;43:1412–9.
Buckley O, Madan R, Kwong R, Rybicki FJ, Hunsaker A. Cardiac masses, part 2: key imaging features for diagnosis and surgical planning. Am J Roentgenol. 2011;197:W842–51.
Stanford W. Advances in cardiovascular CT imaging: CT clinical imaging. Int J Cardiovasc Imaging. 2005;21:29–37.
Rahbar K, Seifarth H, Schafers M, et al. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med. 2012;53:856–63.
Ngaage DL, Mullany CJ, Daly RC, et al. Surgical treatment of cardiac papillary fibroelastoma: a single center experience with eighty-eight patients. Ann Thorac Surg. 2005;80:1712–8.
Simpson L, Kumar SK, Okuno SH, et al. Malignant primary cardiac tumors: review of a single institution experience. Cancer. 2008;112:2440–6.
Donsbeck AV, et al. Primary cardiac sarcomas: an immunohistochemical and grading study with long-term follow-up of 24 cases. Histopathology. 1999;34:295–304.
Reardon MJ, Walkes J-C, Benjamin R. Therapy insight: malignant primary cardiac tumors. Nat Clin Pract Cardiovasc Med. 2006;3:548–53.
Ikeda H, Nakamura S, Nishimaki H, et al. Primary lymphoma of the heart: case report and literature review. Pathol Int. 2004;54:187–95.
Van Dantzig J, Delemarre BJ, Bot H, Visser CA. Left ventricular thrombus in acute myocardial infarction. Eur Heart J. 1996;17:1640–5.
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Myxoma apical four-chamber (see Fig. 25.2). Apical four-chamber view shows tethering of the myxoma to the interatrial septum and prolapse through the mitral valve into the left ventricle. This was associated with the characteristic tumor “plop” on auscultation (AVI 5673 kb)
Myxoma parasternal short axis (see Fig. 25.2). Parasternal short axis view shows tethering of the myxoma to the interatrial septum and prolapse through the mitral valve into the left ventricle. This was associated with the characteristic tumor “plop” on auscultation (AVI 6031 kb)
Papillary fibroelastoma (see Fig. 25.3). This 48-year old female presented with palpitations. Stress echocardiography incidentally revealed a 1.1 cm mobile mass on the aortic aspect of the right coronary cusp. Although otherwise asymptomatic, resection was advised due to embolic risk. She underwent a minimally invasive surgery in which the tumor and its thin stalk was resected, with no further valve repair required (AVI 2669 kb)
Lipoma and tamponade (see Fig. 25.4). Patient developed complications from bother lung cancer including partial superior vena cava (SVC) syndrome and pericardial tamponade, requiring pericardiocentesis and, ultimately, a pericardial window for palliation (AVI 7972 kb)
Renal cell cancer RA inflow (see Fig. 25.5). Thrombus and renal cell cancer. Apical four-chamber echocardiographic view of a mobile mass in the right atrium which is not anchored to the interatrial septum and is seen in right atrial inflow views (AVI 3911 kb)
Caseous mitral annular calcification (see Fig. 25.6). TEE apical five-chamber view zoomed in on a spherical 3.5 cm heterogeneously echogenic mass which appears within the mitral annulus and protrudes into the left ventricular cavity, in an 80-year old female presenting with fever and retinal artery occlusion. Note the acoustic shadowing (black ray cast by calcification on the atrial surface of the mass, which prevents the ultrasound beams from passing through and obscures a narrow wedge of the left ventricle) (AVI 5965 kb)
A discrete mobile mass was noted near the apical portion within the left ventricular cavity, associated with the mitral subvalvular apparatus. Apical two-chamber echo view, in which intravenous echo contrast demonstrates that the mass is not vascular (is not perfused by contrast) (AVI 5308 kb)
Cardiac MRI of the same mass as in Video 25.6a demonstrating it to be a bilobed papillary muscle (WMV 169 kb)
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Wu, J.C. (2014). Cardiac Tumors and Masses. In: Stergiopoulos, K., Brown, D. (eds) Evidence-Based Cardiology Consult. Springer, London. https://doi.org/10.1007/978-1-4471-4441-0_25
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DOI: https://doi.org/10.1007/978-1-4471-4441-0_25
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