19 Intra-cardiac masses Flashcards
Why do thrombi form?
Virchow’s triad (blood stasis, endothelial injury and hypercoagulability).
Where do thrombi form?
Typically, thrombi are visualised in the LA or LAA in patients with AF, in the LV apex in patients with LV dysfunction (apical RWMAs), and/or apical aneurysms secondary to a cardiomyopathy or an MI, in the RA in patients with implanted cardiac devices, or in the heart in patients with prosthetic valves.
Describe the echo characteristics of thrombi.
Acute thrombi are homogenous and regular, smooth or lobulated and mobile or fixed.
Chronic thrombi are calcified, echogenic and fixed.
What are the types of cardiac tumour?
Benign primary cardiac tumours (e.g. include myxomas and fibroelastomas), malignant primary cardiac tumours (e.g. angiosarcomas and lymphomas) and secondary cardiac tumours.
Describe the echo characteristics of cardiac tumours.
Typically, papillary fibroelastomas are located on the AV and/or MV and are distinct, small, mobile, pedunculated and echogenic (shimmering).
Typically, rhabdomyomas are present in multiples, located within the ventricles, and are homogenous, spherical or ovoid and echogenic.
Typically, angiosarcomas are located in the RA, are heterogenous, irregular and wide, and are associated with right sided obstruction and cardiac tamponade.
Typically, lymphomas are located in the RA or the pericardium, are homogenous and isoechoic, and are associated with pericardial effusions.
Typically, metastatic cardiac tumours are located within the pericardium, differ in appearance, and are associated with epicardial and pericardial thickening and/or pericardial effusions.
What are myxomas?
Myxomas are the most common benign cardiac tumours. Myxomas may be sporadic, familial or part of a complex (e.g. Carney complex).
Describe the echo characteristics of myxomas and how these differ from other cardiac tumours.
Typically, myxomas are located in the LA and are attached to the IAS, at the level of the fossa of ovalis, by a pedunculated stalk. Typically, myxomas are heterogenous and irregular, smooth or lobulated, pedunculated and mobile (may prolapse via the MV during diastole). Myxomas show small areas of lucence and speckles of calcium.
Myxomas are more common than other cardiac tumours, myxomas are located within the LA (papillary fibroelastomas attach to the valves and rhabdomyomas are located in the ventricles and sarcomas are located in the RA and RV), myxomas are pedunculated and mobile, other cardiac tumours differ in appearance, and myxomas can cause obstructive symptoms including embolisation, syncope and HF.
Describe the echo characteristics of vegetations.
Vegetations are located on the upstream side of the MV and AV, are small, irregular, echogenic, and are mobile (oscillate or prolapse).
Describe the echo characteristics of cysts.
A 1-5cm oval cavity in the pericardial space like a loculated pericardial effusion.
What are the echo characteristics of malignant cardiac masses?
Irregular shapes, lobulated borders, infiltration into other areas, heterogeneous echogenicity, fast growth, low mobility and/or pericardial effusions.
