CARDIAC IMAGING 4 Flashcards
Anomalous origin of both coronary arteries from left sinus of Valsalva
RCA is ectopic
Anomalies of course:
- Retroaortic course
- Prepulmonic course
Axial MIP image shows common origin of RCA and left main coronary artery from left aortic sinus. Anomalous inter-arterial course of RCA between aorta (AO) and pulmonary artery (PA).
Anomalous origin from opposite coronary sinus
- Both coronary arteries from right sinus of Valsalva
- Ectopic LCA takes an acute angle behind PA
- 30% sudden death (infarction)
https: //www.jbsr.be/articles/872/print/
3a: Coronary CT angiography showing the origin of left main coronary artery (black arrow) from the right coronary sinus with prepulmonic course; 3b:Coronary CT angiography showing the anterior interventricular vein (black arrow) draining directly to the left atrium.
The illustration in the left upper corner is the most common and clinically significant anomaly.
There is an anomalous origin of the LCA from the right sinus of Valsalva and the LCA courses between the aorta and pulmonary artery.
This interarterial course can lead to compression of the LCA (yellow arrows) resulting in myocardial ischemia.
The other anomalies in the figure on the left are not hemodynamically significant.
https://radiologyassistant.nl/cardiovascular/anatomy/coronary-anatomy-and-anomalies
What are the most common forms of Congenital heart disease?
The most common structural defects are:
- bicuspid aortic valve
- mitral valve prolapse (MVP)
most of which are asymptomatic.
2 Anomalies of coronary artery termination
- Congenital coronary AV fistula
- Both arteries are orthotopic.
- Venous side of fistula originates in RA, coronary sinus, or RV
- Coronary cameral fistula
- Coronaries terminating in a cardiac chamber
- Case Discussion
- Coronary arteriovenous fistula (white arrow) on axial arterial phase MIP CT. The MIP image nicely shows diffusion of the resulting contrast blush within the pulmonary artery.
- This findings are noticed incidentally at CT cardiac imaging for coronary stents visualisation.
- In this case surgical correction was not indicated due to asymptomatic clinical presentation and elderly age.
- CT follow-up was recommended.
- Case courtesy of Dr Irina Haidzel, Radiopaedia.org, rID: 58931
What is 3 on this diagram?
Variant anatomy
Kugel artery: collateral that connects the SA nodal artery and the AV nodal artery (anastomotic artery magnum)
What is labeled ‘1’ on this diagram?
Vieussens ring: collateral branches from right conus artery to LAD.
What are the 3 stages of Atherosclerotic CAD?
Atherosclerotic CAD ( Fig. 2.78 )
Now recognized as an inflammatory condition with established cascade of events. Three stages:
- Intimal fatty streaks (nonobstructive, clinically silent)
- Development of active inflammation with monocyte recruitment, macrophages (foam cells), fibrous plaques during adulthood (narrowing of lumen: angina)
- Late occlusive disease: calcifications, hemorrhage (angina, AMI)
What are the 7 main risk factors for coronary artery disease?
- Strong correlation
- Elevated CRP, LDL
- Family members with atherosclerotic disease
- Smoking
- HTN
- Hyperlipidemia
- Diabetes
- Male
- Weaker correlation
- Obesity
- Stress
- Sedentary life
What is the treatment for coronary artery disease?
Treatment
- Reversal of risk factors (diet, smoking cessation)
- Medication (statins)
- Transluminal coronary angioplasty, coronary stents
- Surgery
- Saphenous vein aortocoronary bypass
- Left internal mammary coronary bypass
What is the annual mortality of:
- One-vessel disease:
- Two-vessel disease:
- Three-vessel disease:
What two factors double mortality?
Annual Mortality
- One-vessel disease: 2%–3%
- Two-vessel disease: 3%–7%
- Three-vessel disease: 6%–11%
- Low EF, doubles mortality
- Abnormal wall motion, doubles mortality
What are the radiographic features of Coronary Artery disease?
Radiographic Features
- Plain radiograph
- Calcification of coronary arteries are the most reliable plain radiograph sign of CAD (90% specificity in symptomatic patients), but calcified coronary arteries are not necessarily stenotic.
- LV aneurysm is the second most reliable plain radiograph sign of CAD.
- It develops in 20% of MIs.
- Location
- Anteroapical wall: 70%
- Inferior wall: 20%
- Posterior wall: 10%
- CHF causing:
- Pulmonary edema
- Least reliable sign of CAD
- Case courtesy of Dr Maxime St-Amant, Radiopaedia.org, rID: 20697
- CT-scan shows an aneurysm which seem to originate from the proximal right coronary artery. The aneurysm collar is larger than it would be expected in a pseudoaneurysm. Coronary angiography could be done to further confirm the diagnosis
Stenosis of ___ is considered significant in all coronary arteries except ___ in which threshold is ___.
Stenosis of >70% (CAD-RADS ≥4) is considered significant in all coronary arteries except left main, in which threshold is 50%.
Stenosis occurs primarily in which arteries?
Coronary angiography
Stenosis occurs primarily in:
Proximal portions of major arteries
LAD > RCA > LCx
Collaterals develop if____ of the coronary diameter is obstructed;
two types of anastomosis:
Collaterals develop if >90% of the coronary diameter is obstructed; two types of anastomosis:
- Connections between branches of the same coronary artery (homocoronary)
- Connections between the branches of the three major coronary arteries (intercoronary)
What are the 6 common pathways of intercoronary anastomoses?
Common pathways of intercoronary anastomoses ( Fig. 2.79 ) in descending order of frequency are:
- Surface of apex
- Surface of pulmonary conus
- Between anterior and posterior septal branches
- In the AV groove: LCx and distal RCA
- On the surface of the RV wall
- On the atrial wall around SA node
In left ventriculography, which view is the most helpful?
What can you evaluate?
Left ventriculography
- RAO view most helpful
- Evaluate
- LV function,
- valvular insufficiency,
- shunts,
- mural thrombus
- Evaluate
What is CAD RADS
what are the different scores?
- GRADING OF STENOSIS ON CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY (CAD-RADS)
- CAD-RADS
- Coronary Artery Disease—Reporting and Data System.
- MODIFIERS:
- If more than one modifier is present, the slash symbol (“/”) should follow each modifier in the following order:
- first, modifier N (nondiagnostic);
- second, modifier S (stent);
- third, modifier G (graft);
- fourth, modifier V (vulnerability).
- If more than one modifier is present, the slash symbol (“/”) should follow each modifier in the following order:
Presentation
Anterior ischaemia on ECG.
Patient Data
Age: 25 years
Gender: Female
Kawasaki Disease (Mucocutaneous Lymph Node Syndrome)
- Idiopathic acute febrile multisystem disease in children.
- Most cases are self-limited and without complications.
- Mortality from AMI: 3%.
- Treatment is with aspirin and gamma globulin.
- Clinical Findings
- Fever and cervical lymphadenopathy
- Desquamating rash on palms/soles
- Vasculitis of coronary arteries
Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 35218
25F hx of Kawasaki and AMI at 8months old.
Right Coronary Artery (RCA): 2 fusiform aneurysms without thrombosis- 1) proximal segment 15 mm long and 8 mm in diameter with mural calcification and 2) mid segment 7 mm long and 6.5 mm in diameter at the origin of a small AM branch.
What sign is this?
What is the anatomy of the structure associated with this sign?
Pericardium Normal Anatomy
- Pericardium consists of two layers:
- External fibrous pericardium
- Internal serous epicardium
- The normal pericardial cavity has 10 to 50 mL of clear serous fluid.
- Normal structures:
- Fat stripe:
- fat on surface of heart beneath pericardium seen on lateral CXR
- Superior pericardial recess (commonly seen by CT or MRI)
- Fat stripe:
Congenital Absence of the Pericardium
- Types:
- May be total or partial.
- Partial absence is more common, occurs mainly on the left and is usually asymptomatic.
- Large defects may cause cardiac strangulation.
- Small defects are usually asymptomatic.
- Radiographic Features
- Total absence of the pericardium
- Mimics the appearance of the large silhouette seen in pericardial effusions
- Partial absence of the pericardium
- Heart is shifted and rotated into left pleural cavity
- PA view looks like an RAO view
- Heart is separated from the sternum on cross-table lateral view
- Left hilar mass: herniated left atrial appendage and pulmonary trunk
- Total absence of the pericardium
- Cardiac CT and MRI
- Total or partial absence of pericardium
- Exaggerated levoposition of heart
- Excess lung tissue between aorta and PA
- Radiographic features
- Plain radiograph
- Chest radiographic findings are usually subtle and non-specific. Features may include:
- apparent elevation of the cardiac apex
- right cardiac border might be indistinct due to leftward displacement and rotation of the heart
- prominent pulmonary artery segment (PA): both the medial and the lateral borders of the main PA might be seen more clearly as a result of the lack of pericardial reflection between the aorta and the PA
- lucency caused by the interposition of the lung between the aorta and main pulmonary artery segment
- the cardiophrenic space is increased on the frontal chest radiograph
- appearances may form the Snoopy sign, which is said to be pathognomonic for pericardial agenesis 18,19
- Case Discussion
- Plain radiograph
Pericardial agenesis (partial) is a rare cardiac defect. Radiologically, it presents with the following :
levoposition of the heart
prominent pulmonary artery
air interface in the aorto-pulmonary window or between the base of the heart and the diapgragm
CT-scan is better than MRI for this diagnosis, since it has better spatial resolution. The pericardial defect will be seen. A complete pericardial defect is a benign condition, while patients with partial agenesis may have cardiac herniation through the defect. They should be managed surgically.
* **Case courtesy of Dr Maxime St-Amant, Radiopaedia.org, rID: 20695**
What is the dx?
What is the underlying pathology?
% that are asymptomatic
- Pericardial Cysts
- Pericardial cysts represent congenital malformations (persistent coelom).
- 90% unilocular, 10% multilocular
- 75% are asymptomatic; occur at all ages
- If there is communication with pericardial cavity, the entity is termed pericardial diverticulum.
- Radiographic Features
- Well-defined, rounded soft tissue density on plain radiograph
- Most common location: cardiophrenic angles
- Other locations: anterior and middle mediastinum
- CT is helpful in establishing diagnosis.
- Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 26335
- Large well-defined mass projects in the right mid-to-lower zones obscures the right heart border.
Case Discussion
The patient underwent excision of this mass via a VATS procedure. Histology demonstrated a pericardial (mesothelial) cyst.
What are the 6 broad categories of causes of Pericardial effusion?
16 causes
- Tumor
- Metastases (melanoma, breast, lung)
- Inflammatory/idiopathic
- Rheumatic heart disease
- Collagen vascular disease
- Dressler syndrome
- Postpericardiotomy syndrome
- Drug hypersensitivity
- Infectious
- Viral
- Pyogenic
- Tuberculosis (TB)
- Metabolic
- Uremia
- Myxedema
- Trauma
- Hemopericardium
- Postoperative (frequently after pacemaker implantation and EP ablations)
- Vascular
- Acute MI
- Aortic dissection
- Ventricular rupture
- Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 43323
What is the dx?
What volume of fluid is required to be detectable?
what sign is this?
Radiographic Features ( Fig. 2.80 )
- Plain radiograph
- >250 mL is necessary to be detectable.
- Oreo cookie sign on lateral view:
- subpericardial fat stripe measures >10 mm (a stripe 1–5 mm can be normal).
- Symmetrical enlargement of cardiac silhouette (water-bottle sign)
- Postsurgical loculated pericardial effusion may mimic an LV aneurysm.
- US
- Study of choice
- Echo-free space between epicardium and pericardium
67-year-old male with history of prosthetic aortic valve stenosis, now with dyspnea on exertion and lower extremity swelling
Vertical retrosternal opaque stripes representative of possible pericardial effusion (“oreo cookie sign”).
https://www.auntminnie.com/index.aspx?sec=olce&sub=mlib&pag=cpages&ce_id=12564&pno=1
What is the dx?
What are the signs of the dx?
- Radiographic Features
- Calcifications are common.
- 50% of patients with calcification have constrictive pericarditis.
- 90% of patients with constrictive pericarditis have pericardial calcification.
- Pericardial calcification is more common in the AV grooves.
- Pericardial thickening >4 mm
- Pleural effusion, 60%
- PVH, 40%
- Elevated RV pressure: dilated SVC and azygos, 80%
Pericardial calcification is noted inferiorly and posteriorly. Sternotomy wires noted.
Case Discussion
Trans-thoracic echocardiography confirmed calcification is pericardial rather than myocardial and also demonstrated constrictive pericarditis. The cause was not determined in this case.
Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 31830
What is the most likely dx and why?
20F
Angiosarcoma:
- most common primary malignant tumor in adults,
- most commonly in the RA and AV groove,
- T2-hyperintense with heterogeneous enhancement
Radiographic features
- Two main morphologic types have been described in angiosarcoma:
-
well-defined mass protruding into a cardiac chamber, usually the right atrium
- CT shows a low-attenuation right atrial mass, which may be irregular or nodular (usually arises from the right atrial free wall)
- contrast material enhancement is heterogeneous
-
diffusely infiltrative mass extending along the pericardium
- pericardial space may be obliterated with haemorrhagic, necrotic tumour debris
-
well-defined mass protruding into a cardiac chamber, usually the right atrium
Case courtesy of Dr Michael P Hartung, Radiopaedia.org, rID: 72108
Case courtesy of Dr Danilo Ferreira Maia, Radiopaedia.org, rID: 66010
Treatment and prognosis
Prognosis is poor, which may be due in part to the delay in diagnosis (patients usually have metastatic involvement at presentation).
What are 3 tumour like masses/lesions in the heart?
- Tumor-like
- Thrombus:
- typically LA or LV,
- T1- and T2-hyperintense when acute,
- hypointense when chronic,
- no enhancement
- Valvular vegetations (clinical endocarditis, valvular destruction)
- Normal anatomic structures
- Eustachian valves (RA)
- Crista terminalis (RA)
- Moderator band (RV) (1st pic)
- Thrombus:
- Case courtesy of Dr Matt A. Morgan, Radiopaedia.org, rID: 31559
Fig. 12.25 Upper row. The crista terminalis varies in size and extent in different individuals. Axial CT scans show how the crista terminalis (arrows) varies in length and thickness. Lower row. Axial CT scans show differing amounts of fat infiltration of the crista terminalis (blue arrows) and varying degrees (from mild to severe) of lipomatous hypertrophy of the septum (yellow arrow). A large crista terminalis can mimic a mass at echo studies.
https://radiologykey.com/12-general-anatomy-of-the-heart/
What is the dx?
Which chamber is it found in?
Figure 2: Cardiac computed tomography axial view demonstrating prominent eustachian valve in the right atrium. RV: right ventricle, RA: right artium.
A 51-year-old man presented with paroxsysmal atrial fibrillation (AF). Transthoracic echocardiography revealed mass of 2.3x0.6 cm adjacent to the superior part of the right atrium (RA) compatible with thrombus. Although thrombus formation in the setting of AF is more common in left atrial appendage and left atrium it can also be seen in right atrial appendage and RA. We performed cardiac computerized tomography (CCT) in order to clarify the nature of mass in RA and exclude coronary stenosis. CCT showed prominent eustachian valve measuring 3.2 cm which was not clear on echocardiography. This case underscores the importance of complementary cardiovascular imaging to facilitate the correct diagnosis.
https://www.sciencerepository.org/prominent-eustachian-valve-mimicking-thrombus-in-right-atrium-diagnosed-with_RDI-2020-2-102#_
Case courtesy of Dr Chris O’Donnell, Radiopaedia.org, rID: 31210
Left atrial appendage thrombus
Filling defect in the left atrial appendage. This is not the typical site of myxoma (the major differential diagnosis). The patient is chronically fibrillating (atrial) thus thrombus is most likely.
Case Discussion
Clot in the left atrial appendage is a potential source of embolism producing ischaemic stroke and infarction of other organs including the spleen, bowel and kidneys.
What is the clinical presentation for this?
What is an association?
Cardiac myxomas, although uncommon are one of the commonest primary cardiac tumours and account for ~50% primary benign cardiac tumours.
Clinical presentation
Approximately 20% of patients are asymptomatic, with myxomas being found incidentally on imaging of the heart 7. Presumably, as the amount of imaging increases, so will this figure.
Clinical features are variable and depend on the location and other associated pathology, e.g. valve destruction. However, a triad of symptoms is recognised 7-8:
-
valvular obstruction
- left sided: dyspnoea, orthopnoea, pulmonary oedema
- right sided: symptoms of right heart failure
-
embolic event
- distribution will depend on the location of the tumour
- most are left sided, and, therefore, most are systemic (brain or extremities)
-
constitutional symptoms
- weight loss, fatigue, weakness
- may resemble infective endocarditis (fever, arthralgia, lethargy)
Associations
An uncommon but well-described association with multiple endocrine neoplasia syndromes has been described, and is known as Carney complex 7-8.
- Case courtesy of Dr Annette Johnstone, Radiopaedia.org, rID: 81633
10yo M
Rhabdomyosarcoma (cardiac)
Cardiac rhabdomyosarcoma is a muscular tumour that arises in the heart.
Epidemiology
They account for only 4-7% of cardiac sarcomas overall but are the most common cardiac malignancy in infants and children. There is a slight male predilection.
Pathology
Location
Cardiac rhabdomyosarcoma has no predilection for any one chamber and may arise anywhere in the myocardium. More likely than other sarcomas to involve or arise from cardiac valves and they are often multiple. May invade the pericardium.
Unlike cardiac angiosarcoma, a portion of the tumour should always involve the myocardium.
Radiographic features
CT may show a smooth or irregular low-attenuation mass in a cardiac chamber. Signal intensity characteristics at MR imaging are variable.
https://radiopaedia.org/cases/cardiac-rhabdomyosarcoma
Case courtesy of Dr Nolan Walker, Radiopaedia.org, rID: 38690
Cardiac lymphoma
Cardiac lymphoma is a rare tumour of the myocardium and/or pericardium. It may be considered as primary or secondary.
Epidemiology
Primary cardiac lymphoma is a rare occurrence, representing only 10% of primary malignant cardiac tumours (1% of all primary cardiac tumours).
Secondary involvement of the heart by disseminated lymphoma (diffuse large B-cell) is more common than primary cardiac lymphoma, but is still a rare occurrence.
Both forms are much more common in patients with HIV/AIDS.
What is the most likely dx?
What are the associations of this condition?
22 weeks gestation, first pregnancy
Age: 25 years
Cardiac rhabdomyoma.
Case Discussion
Approximately 6 mm, rising from left ventricle apex, grown into the ventricle, well marginated, hyperechoic solid mass.
This case is an example of the most common intrauterine fetal cardiac tumour - cardiac rhabdomyoma.
INTRO
Cardiac rhabdomyomas are a type of benign myocardial tumour and are considered the most common fetal cardiac tumour. They have a strong association with tuberous sclerosis.
Epidemiology
Cardiac rhabdomyomas are often multiple and can represent up to 90% of cardiac tumours in the paediatric population 1. The majority are diagnosed before the age of 1 year. The estimated incidence is at ~1 in 20,000 births 8.
Clinical presentation
The majority of cardiac rhabdomyomas are asymptomatic although there can be a broad clinical spectrum. Occasionally, they may present with left ventricular outflow tract obstruction or refractory arrhythmias.
Pathology
It is a hamartomatous lesion consisting of cardiac muscle tissue (derived from embryonal myoblasts). Macroscopically, they appear as yellow-tan solid, circumscribed, unencapsulated lesions. Microscopically, a characteristic spider cell is seen which is a large clear cell with cytoplasmic strands composed of glycogen extending to the plasma membrane.
Location
They may arise anywhere in the myocardium but are more common in the ventricles (may involve the left ventricle the most) 6.
Associations
there is a well-known association with tuberous sclerosis, with >50% of all cardiac rhabdomyomas found in patients with later confirmed tuberous sclerosis 1,2
congenital renal anomalies 8
Case courtesy of Dr Ersen Alp Özbalcı, Radiopaedia.org, rID: 37043
Papillary fibroelastoma
most common tumor of valves, usually <1.5 cm, atrial surface of AV valves and aortic surface of aortic valve
Cardiac fibroma
second most common benign cardiac tumor in children, RV free wall, T1- and T2-hypointense, may or may not enhance
Cardiac fibromas, also known as cardiac fibromatosis, are benign congenital cardiac tumours that usually manifest in children.
Epidemiology
Cardiac fibromas are tumours that primarily affect children (most cases are detected in infants or in utero) with a ratio of 4:1 compared with adults 5. They are the second most common benign primary cardiac tumour in children after cardiac rhabdomyoma and second most frequent fetal cardiac tumour 2.
Clinical presentation
Cardiac fibromas are often associated with arrhythmias which can be a presenting feature. They can also cause haemodynamic compromise and congestive heart failure. These tumours also may be found incidentally in asymptomatic patients.
Pathology
Microscopic appearance
Cardiac fibromas represent a collection of fibroblasts interspersed among large amounts of collagen (some authors believe that this tumour is a hamartoma rather than a neoplasm).
Macroscopic appearance
These tumours are well-defined, solitary, intramyocardial lesions with smooth margins and usually large, with a mean diameter of ~5 cm and may obliterate the ventricular cavity.
They almost always arise in the left ventricular free wall, interventricular septum or right ventricular free wall (in descending order) 5.
Unlike many primary cardiac tumours, fibromas usually have no foci of cystic change, haemorrhage, or necrosis. Calcification is a common finding.
Associations
There is an increased prevalence of cardiac fibromas in Gorlin syndrome
Case courtesy of Dr Jayanth Keshavamurthy, Radiopaedia.org, rID: 39267
Cardiac Lipoma
Lipoma: second most common benign adult cardiac tumor, fat signal, no enhancement
Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 15292
Cardiac Hemangioma: capillary, cavernous, or AV malformation, may involve any chamber, T1-hypointense, T2-hyperintense, heterogeneous enhancement
Findings: Her cardiac CT showed one space-taking lesion of soft tissue density confined in right atrium, without extension into adjacent organ. Cardiac MRI showed one well-defined intra-cardiac mass in right atrium attaching to myocardium. The tumor showed intermediate to bright on T1- and T2-weighted images and enhancement after Gd-DTPA administration.
Diagnosis: Cardiac hemangioma
Discussion: The most frequent mass within a cardiac chamber is thrombus. The overall frequency of cardiac tumor is 0.15 percent in echocardiographic series. Of all cardiac tumors, primary tumors are rare, while secondary tumors are about 40 times more frequent than primary cardiac tumors.
Cardiac hemangiomas are composed of endothelial cells that line interconnecting vascular channels. They are usually asymptomatic when diagnosed after infancy, and the commonest presentation is dyspnea on exertion if symptomatic.
Imaging findings: Cardiac hemangiomas may involve the endocardium, myocardium, or epicardium. They can arise from all chambers and also pericardium. On T1-weighted images, hemangiomas are intermediate to hyperintense. On T2-weighted images, they are hyperintense to myocardium. After Gd-DTPA administration, they usually have rapid enhancement during first-pass Gd contrast infusion because of their high vascularity, and usually show intense but inhomogeneous enhancement
Differential diagnosis: There are some methods to differentiate between thrombus and tumor on medical images. A thrombus shows low signal intensity on gradient-echo images, while tumors are hyperintense to myocardium. However, exceptions to this generalization are fresh blood clot can have high signal intensity, and some myxomas containing iron produce low signal and mimic thrombus. Besides, thrombus does not enhance after the administration of Gd-DTPA, whereas tumors show enhancement.
About 80 percent of primary cardiac tumors are benign, including myxoma, lipoma, papillary fibroelastoma, rhabdomyoma, and hemangioma. Cardiac pheochromocytoma is also reported and is very rare. Myxoma is the most common benign cardiac tumor. Myxoma is dumbbell shape, and is usually mobile with its shape varied during cardiac cycle.
One-fourth of primary cardiac tumors are malignant, with sarcomas being the most common, followed by primary cardiac lymphomas. There are features indicating malignancy of a primary cardiac tumor on medical images, including involvement of more than 1 cardiac chamber, wide point of attachment to the wall, necrosis within the tumor, extension outside the heart, and hemorrhagic pericardial effusion. Other signs of malignancy include intramural and intracavitary location, extension into the mediastinum, and rapid growth.
Conclusion: Cardiac hemangioma is a rare benign tumor of the heart. The differentiation of this benign tumor from the malignant types is essential in planning subsequent management. Cardiac MRI is a valuable tool to differentiate this tumor from other benign and malignant tumors.
https://www.diagnosticimaging.com/view/cardiac-hemangioma
Primary Cardiac Osteosarcoma:
• Osteosarcoma: rare, dense calcifications better demonstrated on CT
- Figure 2 Four-chamber reconstruction from retrospectively gated cardiac CT angiography demonstrates a 6 × 5.6-cm mass with internal calcifications that fills a large portion of the left atrium and extends to the mitral valve (black arrow).
- The mass has invaded the left inferior pulmonary vein (black arrowheads) and left superior pulmonary vein (not shown).
- The mass also obstructs the ostium of the right inferior pulmonary vein (white arrowheads).
- A linear area of calcification in the left ventricular wall (white arrow) was suggestive of a metastatic lesion.
https://pubs.rsna.org/doi/full/10.1148/rg.2015140265
