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DMST 367 Echo 3 > Cardiac Masses > Flashcards

Cardiac Masses Flashcards

1
Q

What does this represent?

A

Aberrant chordae

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2
Q

What is the arrow pointing to?

A

Crista terminalis

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3
Q

What is the arrow pointed to?

A

Eustachian valve

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4
Q

What can we see in the RA?

A

Chairi network

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5
Q

What does this image represent?

A

Persistent left superior vena cava

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6
Q

Fill in the chart

A
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7
Q

Label

A
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8
Q

What does this image represent?

A

Myxoma

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9
Q

When do we hear with a myxoma?

A

During diastole on the S1 maybe S2

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10
Q

What can you notice about this image? (Look at the mass, it would be moving in and out)

A

Myxoma in PLAX

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11
Q

What is this mass?

A

Myxoma - tiny necrotic areas A3C zoom LA

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12
Q

What does this image?

A

Myxoma, and we would hear a mitral stenosis murmur - diastolic rumble at the apex

This can also be called a plop

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13
Q

What does this image represent? What view is this?

A

Myxoma in TEE (there is a Myxoma in he RA)

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14
Q

What does this image represent?

A

Lambl’s excrescence

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15
Q

Lambl’s excrescence is seen where?

A

Usually at the valves

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16
Q

What does this image represent?

A

Papillary fibroelastoma

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17
Q

What does this image represent?

A

Lipoma

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18
Q

What does this image represent?

A

Lipoma

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19
Q

What does this image represent?

A

Lipomatous hypertrophy of the IAS

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20
Q

What is the arrows pointing to?

A
  1. Foramen ovale flap on top
  2. Atrial septal walls on bottom
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21
Q

What does this image represent?

A

Lipomatous hypertrophy of the IAS

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22
Q

What is the arrows pointing to?

A

Rhabdomyoma

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23
Q

What does this image represent?

A

Angiosarcoma

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24
Q

What does this image represent?

A

Rhabdomyosarcoma

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25
Q

What does this image represent?

A

Metastatic tumor

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26
Q

What does this image represent?

A

Carcinoid doppler (Severe/ Massive TR)

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27
Q

What does this image represent?

A
  1. Dilated IVC on the right (due to Carcinoid)
  2. Hepatic vein reversal (due to Carcinoid)
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28
Q

What does this image represent?

A

Metastatic IVC tumour

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29
Q

What is the definition of a cardiac mass?

A

An abnormal structure in or immediately adjacent to the heart

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30
Q

What are 3 basic types of cardiac masses?

A
  1. Tumor
  2. Thrombus
  3. Vegetation
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31
Q

What are 5 advantages of echo evaluations for masses?

A
  1. Dynamic evaluation
  2. Anatomic structure and tissue characterization
  3. Physiologic effect of mass
  4. Associated abnormalities
  5. Predisposing factors
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32
Q

What are two disadvantage for for echo evaluation of masses?

A
  1. Suboptimal image quality
  2. Mistaking artifact for a mass
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33
Q

How are three ways we can differentiate a mass from normal or variant structures? (Think Artifact)

A
  1. Near field artifact “ring down”
  2. Beam width artifact
  3. Double image artifact
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34
Q

What is another name for aberrant chordae?

A

false tendon

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35
Q

What is aberrant chordae?

A

Chordae attaching from the free wall or pap muscle to the IVS

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36
Q

What are three RA structures that mimic masses?

A
  1. Crista terminalis
  2. Eustachian valve
  3. Chiari network
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37
Q

What is the crista terminalis?

A

Small crescent shaped ridge near the SVC and fossa ovalis

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38
Q

What is the eustachian valve?

A

Membranous structure (flap) near the IVC extending towards the fossa ovalis

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39
Q

What are three things to note about the chiari network?

A
  1. It is a delicate membranous structure in the RA near the IVC
  2. It is highly mobile
  3. Acts like a valve for the coronary sinus
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40
Q

What are two types of cardiac tumors?

A
  1. Primary
  2. Metastatic
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41
Q

Which type of cardiac tumor is much more common?

A

Metastatic

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42
Q

What is the malignancy of primary cardiac tumors?

A

Can be either benign or malignant

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43
Q

What is a myxoma?

A

A benign tumor that is usually attached by a stalk to the internal septum (IAS)

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44
Q

Which side carries myoxma’s most commonly?

A

LA

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45
Q

What is the sound of Myxoma?

A

Plop sound

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46
Q

How mobile are myxoma’s?

A

May be mobile with blood flow

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47
Q

What can Myxoma’s mimic? How?

A

May mimic MS/TS by partially or completely prolapsing in to the left

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48
Q

What is the demographic that is affected most by myxomas?

A

Female: male - 2:1

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49
Q

What are s/s of myxomas? 3

A
  1. s/s of CHF
  2. s/s of MS/TS
  3. Embolism
50
Q

What are CT/MRIs in terms of discerning Myxomas?

A

Useful for tissue characterization

51
Q

What does Myxomas look like on ECG? 2

A
  1. A-Fib
  2. A-Flutter
52
Q

What are two complication of myxoma’s?

A
  1. Embolization
  2. Infected/ necrotic myxoma’s
53
Q

How many cases of Myoxma’s embolize? What does this lead to? 2

A
  1. 40- 50% of pts with LA Myxoma
  2. Sudden death
54
Q

What is infected/ necrotic myxomas associated with?

A

Highly associated with stroke/ TIA

55
Q

What are two treatments for Myxomas? 2

A
  1. Serial echocardiography
  2. Surgical
56
Q

What is a disadvantage of using serial echocardiography for treatment of myxoma?

A

High rate of recurrence

57
Q

What is the surgical process for myxoma’s? 3

A
  1. Prompt surgical excision of myxoma and surrounding tissue
  2. Woven dacron patch is used to replaced portion of IAS
  3. Mitral Annuloplasty - if distorted
58
Q

What is the Myxoma attached to in 2D?

A

IAS 83% of the time

59
Q

What view is best used to see Myxomas?

60
Q

What can be said about the areas with myxomas?

A

Necrotic areas

61
Q

Necrotic tumors have a higher chance of what?

A

Embolization

62
Q

What does Myxoma do to the LA?

A

Enlarge it

63
Q

What is the size of a Myxoma? 2

A
  1. Most between 5-6cm
  2. Can be up to 15 cm
64
Q

When looking at myxoma with TEE, what can be see? 6

A
  1. Pedunculation
  2. Cystic altercations
  3. Focal calcifications
  4. Differentiating mass vs normal variant
  5. Valve damage/ regurg
  6. ASD
65
Q

What are some other names for papillary fibroelastoma (PFE)? 4

A
  1. Cardiac papilloma
  2. Papillary fibroma
  3. Papillary endocardial tumor
  4. Giant Lambl’s excrescence
66
Q

What is the most common valvular heart tumor?

A

Papillary fibroelastoma (PFE)

67
Q

What is the malignancy of PFEs?

68
Q

In terms of PFE 85% are _________ with small ________. May also attach to the _______________ 3

A
  1. Valvular
  2. Pedicle
  3. Endocardium
69
Q

What is the motion of PFE to the valve?

A

Independent

70
Q

What increases the incidence of Lambl’s excrescence?

71
Q

Lambl’s excrescence is a normal variation in which demographic?

72
Q

What is the clinical sign for Lambl’s excrescence?

A

No clinical sign

73
Q

What is usually mistaken for vegetations or PFE?

A

Lambl’s excrescence

74
Q

How many lambl’s excrescence are there normally?

A

Usually multiple

75
Q

Papillary fibroelastoma sometimes mimics the appearance of what?

A

vegetation

76
Q

What is the most common and common locations of papillary fibroelastoma? 2

A
  1. AV most common
  2. MV common
77
Q

Where is papillary fibroelastomas rarely found on? 4

A
  1. PV
  2. LVOT
  3. Pap muscles
  4. Chordae
78
Q

PFEs are rarely how big?

79
Q

What does PFEs look like? 4

A
  1. Small
  2. Mobile
  3. Pedunculated
  4. Echodense mass
80
Q

What is PFEs associated with? 2

A
  1. Regurg of the affected valve
  2. No stenosis due to small size though
81
Q

What is a lipoma?

A

Echogenic, encapsulated tumor

82
Q

Where are lipomas found?

A

In the IAS, LV, or RA

83
Q

How big might lipomas get? Where might they attach?

A

May be massive and may attach to an AV valve

84
Q

What does Lipomas look like 2D?

A

Big and Bright

85
Q

What shows the best visibility for Lipomas?

A

A4C and Subc

86
Q

What is the normal thickness of IAS?

87
Q

What are lipoma size ranges?

A

1.5 - 3.0 cm and even up to 7-8 cm

88
Q

Lipomatous hypertrophy of the IAS is asymptomatic or symptomatic?

A

Usually Asymptomatic

89
Q

What kind of tumor is a lipomatous hypertrophy of the IAS?

A

Not a true tumor, but fatty infiltration

90
Q

What is the appearance of Lipomatous hypertrophy of the IAS?

A

Dumbbell appearance

91
Q

How might Lipomatous hypertrophy of the IAS may impact inflow in the atria

A

If the atria is large

92
Q

What is Lipomatous hypertrophy of the IAS associated with? 8

A
  1. Old age
  2. Obesity
  3. Diabetes
  4. SVT
  5. Pericardial effusion
  6. arterial embolization
  7. Pulmonary emboli
  8. Sudden cardiac death
93
Q

What is the most common benign tumor in children?

A

Rhabdomyoma

94
Q

What does rhabdomyoma look like?

A

Striated muscle tumor

95
Q

How many rhabdomyoma tumors are there usually?

96
Q

What is rhabdomyomas associated with?

A

Tuberous sclerosis

97
Q

What does rhabdomyoma look similar to with echo?

A

Rhabdomyosarcoma

98
Q

What are 5 primary malignant tumors?

A
  1. Angiosarcoma
  2. Rhabdomyosarcoma
  3. Mesothelioma
  4. Fibrosarcoma
  5. Malignant lymphoma
99
Q

What is the most common primary malignant tumor?

A

Angiosarcoma

100
Q

Where does angiosarcomas commonly present?

101
Q

What is Angiosarcomas usually associated with? 5 (s/s)

A
  1. Chest pain
  2. CHF
  3. Vena cavae obstruction
  4. Arrythmias
  5. Death
102
Q

What is the mean survival on angiosarcomas?

103
Q

What does Angiosarcoma look like 2D? 2

A
  1. Large mass
  2. Extends to the pericardium, vena cava, or TV
104
Q

What does angiosarcoma look like with doppler?

A

May show obstruction of affected valve

105
Q

What does angiosarcomas do?

A

Invades surrounding structures

106
Q

What is the 2nd most common type of primary sarcomas?

A

Rhabdomyosarcomas

107
Q

Rhabdomyosarcomas are common in which demographic?

A

Kids/ Young adults

108
Q

Rhabdomyosarcomas may be found in what chambers ?

109
Q

Rhabdomyosarcoms are singular or multiple?

110
Q

What is Rhabdomyosarcoma made of?

A

Striated muscle

111
Q

What is Rhabdomyosarcomas associated with?

A

Tuberous sclerosis

112
Q

How much more common are metastatic tumors then primary tumors

A

20-40x more common

113
Q

What are metastatic tumors have more often?

A

Pericardial effusions

114
Q

What are some examples of metastatic tumors? 6

A
  1. Melanoma
  2. Bronchial Ca
  3. Breast Ca
  4. Lymphoma
  5. Renal Cell Ca
  6. Pancreatic Ca
115
Q

Metastatic tumors may do what to flow in the IVC/SVC?

A

Obstruct flow

116
Q

Carcinoid heart disease starts as what?

A

A carcinoid tumor elsewhere and metastasizes to the heart

117
Q

Where does carcinoid heart tumors usually metastasize from?

A

Liver/ ilium

118
Q

The CHD tumor secretes what?

A

5HT or 5- hydrooxythryptamine

119
Q

What are the clinical S/S for carcinoid heart disease? 3

A
  1. Cutaneous flushing
  2. Diarrhea
  3. CHF
120
Q

What does carcinoid heart disease look like on 2D? 5

A
  1. Thickened/ retracted TV leaflets
  2. Leaflets may become totally fixed
  3. RAE/ RVE, RVH
  4. RVVO
  5. Pericardial effusion
    Look for liver METS
121
Q

What does TR look like with Carcinoid tumors?

A

Severe/ Massive TR

DMST 367 Echo 3 (27 decks)

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