Cardiac masses Flashcards
DDx cardiac mass
Thrombus Vegetation Metastatic Primary neoplasm Artifact
Metastatic cardiac masses
Melanoma, breast, lung most common
Also RCC, lymphoma, carcinoid
Echo metastatic cardiac mass
Mass doesn’t respect tissue planes
>60% pericardial involvement
Primary cardiac neoplasms (malignant)
Leoimyosarcoma Fibrosarcoma Osteosarcoma Rhabdomyosarcoma Angiosarcoma Lymphoma
Leiomyosarcoma
Prefers LA
Smooth muscle cells
MV and PV involvement
Surgical tx +/- chemo/rad
Fibrosarcoma
LA
Fibroblasts
Primary pericardial tumor
Osteosarcoma
LA
Bone producing cells
Calcified mass
Rhabdomyosarcoma
No chamber preference
Younger
Striated muscle cells
Nodular pericardial involvement
Angiosarcoma
Atrial, AV groove, prefer R side Endothelial cells Pericardial extension Very vascular, bloody Usually discovered late 3:1 M:F
Lymphoma
RA
B cell
Pericardial involvement
Benign neoplasms
Myxoma
Rhabdomyoma
Fibroma
Myxoma
LA, RA
Attaches to atrial septum with narrow stalk
Should be resected
Myxoma syndrome
Atypical location
skin, mucosa, cardiac
Famkily history
Carney syndrome
Atypical location of myxoma, endocrine symptoms, pigmented lesions
Rhabdoymyoma
Most common benign in children
A/w tuberous sclerosis
Often multiple, ventricular wall / AV valves
Regress spontaneously
Fibroma
LV fee wall, septum or apex Well demarcated Grows into cavity, may interfere with filling Often multiple CHF, VT
Valvular masses
Papillary fibroelastoma
Lambl’s excresance
Immune mediated vascular disease
Blood cyst
Papillary fibroelastoma echo
Attached by a stalk Any endocardial surface Independent motion Small, 1.0 cm, usually single Shimmering edge Arterial side of semilunar valves, atrial surface of AV valves
Lambl’s excresance
Closure margin of valve
Linear, AV > MV
Increased with age, degenerative
Immune mediated vascular
Malignancy SLE APLS Highly embolic Libman-Sacks
Libman-Sacks
Small, nodule, relatively non-mobile mass on valve closure plane
Blood cyst
Thin walled, multi-lobed, cystic
Attachment to valve leaflet
Echo Lucent core
AV groove masses
Pericardial cyst
Lipomatous hypertrophy
Coronary artery aneurysm
Pheochromocytoma
Pericardial cyst
No contrast, benign
Right AV groove, diaphragm
Clear center, fluid filled
Continuous with pericardium
Lipomatous hypertrophy
Right AV groove, atrial septum
Can be extensive
Dumbbell appearance, fossil ovalis preserved
Usually benign, no sx
Pheochromocytoma
Right AV groove
Well demarcated, own blood supply
Class I echo for mass
Clinical syndrome suggesting mass
Follow-up after surgery if likely to recur
Treatment depends on echo
Malignancy assessing for cardiac involvement and staging
Class IIb echo for mass
Screening for disease state likely to result in mass formation without clinical evidence of mass
Myxoma symptoms
Intracardiac obstruction - dyspnea, syncope, palps
Systemic embolization
Constitutional symptoms
Synovial sarcoma
Translocation between chromosome 18 and the X chromosome
Malignant primary cardiac sarcoma, very rare, poor prognosis
Chiari network
Remnant of right valve of sinus venosus
Fibers in RA from IVC orifice
2-3% normal hearts
Pericardial cyst CXR
May be seen on CXR with rounded mass along right heart
Papillary fibroelastoma surgery indication
Embolic events
Events due to tumor mobility (coronary postal occlusion)
Highly mobile or late >1 cm
Metastatic melanoma
Most commonly charcoal heart - tumors studding pericardium
Can also be solid intracardiac mass
