Cardiac Masses Flashcards
1
Q
What does this represent?
A
Aberrant chordae
2
Q
What is the arrow pointing to?
A
Crista terminalis
3
Q
What is the arrow pointed to?
A
Eustachian valve
4
Q
What can we see in the RA?
A
Chairi network
5
Q
What does this image represent?
A
Persistent left superior vena cava
6
Q
Fill in the chart
A
7
Q
Label
A
8
Q
What does this image represent?
A
Myxoma
9
Q
When do we hear with a myxoma?
A
During diastole on the S1 maybe S2
10
Q
What can you notice about this image? (Look at the mass, it would be moving in and out)
A
Myxoma in PLAX
11
Q
What is this mass?
A
Myxoma - tiny necrotic areas A3C zoom LA
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
13
Q
What does this image represent? What view is this?
A
Myxoma in TEE (there is a Myxoma in he RA)
14
Q
What does this image represent?
A
Lambl’s excrescence
15
Q
Lambl’s excrescence is seen where?
A
Usually at the valves
16
Q
What does this image represent?
A
Papillary fibroelastoma
17
Q
What does this image represent?
A
Lipoma
18
Q
What does this image represent?
A
Lipoma
19
Q
What does this image represent?
A
Lipomatous hypertrophy of the IAS
20
Q
What is the arrows pointing to?
A
- Foramen ovale flap on top
- Atrial septal walls on bottom
21
Q
What does this image represent?
A
Lipomatous hypertrophy of the IAS
22
Q
What is the arrows pointing to?
A
Rhabdomyoma
23
Q
What does this image represent?
A
Angiosarcoma
24
Q
What does this image represent?
A
Rhabdomyosarcoma
25
What does this image represent?
Metastatic tumor
26
What does this image represent?
Carcinoid doppler (Severe/ Massive TR)
27
What does this image represent?
1. Dilated IVC on the right (due to Carcinoid)
2. Hepatic vein reversal (due to Carcinoid)
28
What does this image represent?
Metastatic IVC tumour
29
What is the definition of a cardiac mass?
An abnormal structure in or immediately adjacent to the heart
30
What are 3 basic types of cardiac masses?
1. Tumor
2. Thrombus
3. Vegetation
31
What are 5 advantages of echo evaluations for masses?
1. Dynamic evaluation
2. Anatomic structure and tissue characterization
3. Physiologic effect of mass
4. Associated abnormalities
5. Predisposing factors
32
What are two disadvantage for for echo evaluation of masses?
1. Suboptimal image quality
2. Mistaking artifact for a mass
33
How are three ways we can differentiate a mass from normal or variant structures? (Think Artifact)
1. Near field artifact "ring down"
2. Beam width artifact
3. Double image artifact
34
What is another name for aberrant chordae?
false tendon
35
What is aberrant chordae?
Chordae attaching from the free wall or pap muscle to the IVS
36
What are three RA structures that mimic masses?
1. Crista terminalis
2. Eustachian valve
3. Chiari network
37
What is the crista terminalis?
Small crescent shaped ridge near the SVC and fossa ovalis
38
What is the eustachian valve?
Membranous structure (flap) near the IVC extending towards the fossa ovalis
39
What are three things to note about the chiari network?
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
40
What are two types of cardiac tumors?
1. Primary
2. Metastatic
41
Which type of cardiac tumor is much more common?
Metastatic
42
What is the malignancy of primary cardiac tumors?
Can be either benign or malignant
43
What is a myxoma?
A benign tumor that is usually attached by a stalk to the internal septum (IAS)
44
Which side carries myoxma's most commonly?
LA
45
What is the sound of Myxoma?
Plop sound
46
How mobile are myxoma's?
May be mobile with blood flow
47
What can Myxoma's mimic? How?
May mimic MS/TS by partially or completely prolapsing in to the left
48
What is the demographic that is affected most by myxomas?
Female: male - 2:1
49
What are s/s of myxomas? 3
1. s/s of CHF
2. s/s of MS/TS
3. Embolism
50
What are CT/MRIs in terms of discerning Myxomas?
Useful for tissue characterization
51
What does Myxomas look like on ECG? 2
1. A-Fib
2. A-Flutter
52
What are two complication of myxoma's?
1. Embolization
2. Infected/ necrotic myxoma's
53
How many cases of Myoxma's embolize? What does this lead to? 2
1. 40- 50% of pts with LA Myxoma
2. Sudden death
54
What is infected/ necrotic myxomas associated with?
Highly associated with stroke/ TIA
55
What are two treatments for Myxomas? 2
1. Serial echocardiography
2. Surgical
56
What is a disadvantage of using serial echocardiography for treatment of myxoma?
High rate of recurrence
57
What is the surgical process for myxoma's? 3
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
What is the Myxoma attached to in 2D?
IAS 83% of the time
59
What view is best used to see Myxomas?
A4C/ Subc
60
What can be said about the areas with myxomas?
Necrotic areas
61
Necrotic tumors have a higher chance of what?
Embolization
62
What does Myxoma do to the LA?
Enlarge it
63
What is the size of a Myxoma? 2
1. Most between 5-6cm
2. Can be up to 15 cm
64
When looking at myxoma with TEE, what can be see? 6
1. Pedunculation
2. Cystic altercations
3. Focal calcifications
4. Differentiating mass vs normal variant
5. Valve damage/ regurg
6. ASD
65
What are some other names for papillary fibroelastoma (PFE)? 4
1. Cardiac papilloma
2. Papillary fibroma
3. Papillary endocardial tumor
4. Giant Lambl's excrescence
66
What is the most common valvular heart tumor?
Papillary fibroelastoma (PFE)
67
What is the malignancy of PFEs?
Benign
68
In terms of PFE 85% are _________ with small ________. May also attach to the _______________ 3
1. Valvular
2. Pedicle
3. Endocardium
69
What is the motion of PFE to the valve?
Independent
70
What increases the incidence of Lambl's excrescence?
Age
71
Lambl's excrescence is a normal variation in which demographic?
Elderly
72
What is the clinical sign for Lambl's excrescence?
No clinical sign
73
What is usually mistaken for vegetations or PFE?
Lambl's excrescence
74
How many lambl's excrescence are there normally?
Usually multiple
75
Papillary fibroelastoma sometimes mimics the appearance of what?
vegetation
76
What is the most common and common locations of papillary fibroelastoma? 2
1. AV most common
2. MV common
77
Where is papillary fibroelastomas rarely found on? 4
1. PV
2. LVOT
3. Pap muscles
4. Chordae
78
PFEs are rarely how big?
Over 1 cm
79
What does PFEs look like? 4
1. Small
2. Mobile
3. Pedunculated
4. Echodense mass
80
What is PFEs associated with? 2
1. Regurg of the affected valve
2. No stenosis due to small size though
81
What is a lipoma?
Echogenic, encapsulated tumor
82
Where are lipomas found?
In the IAS, LV, or RA
83
How big might lipomas get? Where might they attach?
May be massive and may attach to an AV valve
84
What does Lipomas look like 2D?
Big and Bright
85
What shows the best visibility for Lipomas?
A4C and Subc
86
What is the normal thickness of IAS?
<1.0cm
87
What are lipoma size ranges?
1.5 - 3.0 cm and even up to 7-8 cm
88
Lipomatous hypertrophy of the IAS is asymptomatic or symptomatic?
Usually Asymptomatic
89
What kind of tumor is a lipomatous hypertrophy of the IAS?
Not a true tumor, but fatty infiltration
90
What is the appearance of Lipomatous hypertrophy of the IAS?
Dumbbell appearance
91
How might Lipomatous hypertrophy of the IAS may impact inflow in the atria
If the atria is large
92
What is Lipomatous hypertrophy of the IAS associated with? 8
1. Old age
2. Obesity
3. Diabetes
4. SVT
5. Pericardial effusion
6. arterial embolization
7. Pulmonary emboli
8. Sudden cardiac death
93
What is the most common benign tumor in children?
Rhabdomyoma
94
What does rhabdomyoma look like?
Striated muscle tumor
95
How many rhabdomyoma tumors are there usually?
Multiple
96
What is rhabdomyomas associated with?
Tuberous sclerosis
97
What does rhabdomyoma look similar to with echo?
Rhabdomyosarcoma
98
What are 5 primary malignant tumors?
1. Angiosarcoma
2. Rhabdomyosarcoma
3. Mesothelioma
4. Fibrosarcoma
5. Malignant lymphoma
99
What is the most common primary malignant tumor?
Angiosarcoma
100
Where does angiosarcomas commonly present?
In the RA
101
What is Angiosarcomas usually associated with? 5 (s/s)
1. Chest pain
2. CHF
3. Vena cavae obstruction
4. Arrythmias
5. Death
102
What is the mean survival on angiosarcomas?
10 months
103
What does Angiosarcoma look like 2D? 2
1. Large mass
2. Extends to the pericardium, vena cava, or TV
104
What does angiosarcoma look like with doppler?
May show obstruction of affected valve
105
What does angiosarcomas do?
Invades surrounding structures
106
What is the 2nd most common type of primary sarcomas?
Rhabdomyosarcomas
107
Rhabdomyosarcomas are common in which demographic?
Kids/ Young adults
108
Rhabdomyosarcomas may be found in what chambers ?
RT>LT
109
Rhabdomyosarcoms are singular or multiple?
Multiple
110
What is Rhabdomyosarcoma made of?
Striated muscle
111
What is Rhabdomyosarcomas associated with?
Tuberous sclerosis
112
How much more common are metastatic tumors then primary tumors
20-40x more common
113
What are metastatic tumors have more often?
Pericardial effusions
114
What are some examples of metastatic tumors? 6
1. Melanoma
2. Bronchial Ca
3. Breast Ca
4. Lymphoma
5. Renal Cell Ca
6. Pancreatic Ca
115
Metastatic tumors may do what to flow in the IVC/SVC?
Obstruct flow
116
Carcinoid heart disease starts as what?
A carcinoid tumor elsewhere and metastasizes to the heart
117
Where does carcinoid heart tumors usually metastasize from?
Liver/ ilium
118
The CHD tumor secretes what?
5HT or 5- hydrooxythryptamine
119
What are the clinical S/S for carcinoid heart disease? 3
1. Cutaneous flushing
2. Diarrhea
3. CHF
120
What does carcinoid heart disease look like on 2D? 5
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
What does TR look like with Carcinoid tumors?
Severe/ Massive TR
