Cardiac Tumors

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    1. Thrombus or vegetations are the most likely etiology
    2. Cardiac tumors are mostly secondary
    3. 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)
    • 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



    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
      • 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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