Table of contents
- 1. Introduction
- 2. Types
.
Introduction
- Thrombus or vegetations are the most likely etiology
- Cardiac tumors are mostly secondary
- Primary cardiac tumors are mostly benign
- Cardiac tumors are extremely rare (<0.1%)
- Found incidentally on cardiac imaging
- Characteristics
- Echo contrast - malignant tumors are vascular, and hyper-enhance (thrombi do not)
- Myxomas get partially enhanced
- Attachment of a mass to an area of abnormal wall motion (typically akinesis or dyskinesis) = likely thrombus
- Attachment to valve = more likely thrombotic (sterile) or vegetation (infectious)
- Echo contrast - malignant tumors are vascular, and hyper-enhance (thrombi do not)
- Consequences
- Embolic Phenomena
- L-sided --> more likely to embolize (i.e. myxoma)
- Pulmonary embolization reported (esp with lymphomas)
- Hemodynamic Consequences
- Reduce cardiac output by obstructing inflow or valvular dysfunction
- Embolic Phenomena
Types
Identified echocardiographically by:
- Location, imaging characteristics, clinical context
- Myxoma
- Most common primary cardiac tumor
- 70-80% in LA
- Mid-portion of atrial septum by narrow stalk (15-20% in RA)
- Heterogeneous mobile mass, two apperances:
- Polypoid myxoma - larger, smooth surface, rough core. Cystic lucencies (hemorrhage, necrosis)
- Obstructs blood flow (HF symptoms)
- Papillary Myxoma - larger, stretched apperance, multiple villi.
- Embolic phenomena
- Polypoid myxoma - larger, smooth surface, rough core. Cystic lucencies (hemorrhage, necrosis)
- Fever, weight loss, anemia, inflammatory markers.
- Management:
- Surgical resection due to high risk of embolism.
- Papillary Fibroelastoma
- 3rd most common
- Can arise from any endocardial surface
- Commonly on valves (aortic and mitral)
- Stippled borders (finger-like projections - "sea anemone")
- Highly mobile stalk
- Often multiple!!
- High risk of embolism (either tumor itself embolizes or causes thrombus)
- Can present as TIA/Stroke
- Management:
- Surgical excision if ≥ 1cm, left-sided, if good surgical candidate.
- R-sided rarely need removal (unless huge)
- Lipoma
- Adipose tissue
- Broad based, immobile, without pedicle, well circumscribed.
- Homogeneous (no calcification)
- Can cause arrhythmias or valve dysfunction (most asymptomatic)
- Rhabdomyoma
- Pediatric population
- Ventricular free walls, (LV or septum) or AV valves.
- Small, well circumscribed (multiple), nodules or a pedunculated mass in cardiac cavity
- Most regress spontaneously
- Follow echocardiographically
- Resection only if obstructing or arrhythmias.
- Fibroma
- 2nd most common
- Pediatric population
- Distinct, well-demarcated, non-contractile, solid, highly echogenic mass (in myocardium)
- Calcification possible
- Locations:
- LV free wall, anterior free wall, septum
- Can extend into cavity, cause obstruction
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