Cardiac Masses

Question 1

Many of the cardiac lesions detected are usually tumor-like lesions, with _________ representing most cases

Answer 1

Thrombus

Question 2

20 to 40 times more common than primary cardiac tumors

Answer 2

Tumors due to metastatic disease

Question 3

First line inaging technique used to evaluate cardiac masses

Answer 3

Echocardiography

Question 4

imaging wherein the heard is imaged throughout the cardiac cycle, may be helpful to demonstrate movement of the mass during the cardiac cycle

Answer 4

restrospective ECG gating

Question 5

imaging modality of choice in evaluating cardiac masses

Answer 5

Cardiac MRI

Question 6

MRI sequence that allows for excellent localization of the mass and simultaneously allows for functional analysis

Answer 6

Gradient echo cine imaging

Question 7

most cardiac tumors demonstrate what MRI signal characteristics

Answer 7

low to intermediate signal on T1W imaging and high signal on T2W imaging

Question 8

Key MRI imaging sequences for evaluation of lesion vascularity and enhancement

Answer 8

Postcontrast T1 based perfusion and late gadolinium enhancement images

Question 9

Size and number of lesions in benign cardiac mass

Answer 9

small, <5 cm and single

Question 10

Usual location of a benign cardiac mass

Answer 10

left sided

Question 11

Marginal characteristics of benign cardiac masses

Answer 11

smooth, well-defined borders, no extension through tissue planes

Question 12

Pericardial involvement in benign cardiac masses

Answer 12

no involvement

Question 13

Tissue characteristics of benign cardiac mass

Answer 13

homogeneous, absent to minimal early enhancement, variable delayed enhancement

Question 14

size and number of lesions in malignant cardiac masses

Answer 14

large, >5 cm, multiple

Question 15

usual location of malignant cardiac mass

Answer 15

right sided

Question 16

margins of a malignant cardiac mass

Answer 16

irregular, ill-defined, direct invasion through tissue places

Question 17

pericardial involvement in malignant cardiac mass

Answer 17

hemorrhagic pericardial effusion, pericardial invasion or multiple nodular masses

Question 18

tissue characteristics of malignant cardiac mass

Answer 18

heterogeneous due to hemorrhage and necrosis, prominent early enhancement, variable delayed enhancement

Question 19

MRI sequence perfromed and prescribed based on the location of cardiac mass

Answer 19

Steady state free precession cine images (SSFP)

Question 20

can aid in the detection of lesions localized near or within the pericardium

Answer 20

myocardial tissue tagging

Question 21

can help detect the presence of a noncontractile intramyocardial mass, such as rhabdomyoma, or differentiate a true mass versus asymmetric focal hypertrophic cardiomyopathy

Answer 21

myocardial tissue tagging

Question 22

MRI technique that can distinguish a thrombus from a tumor

Answer 22

longer invesion recovery times (such as 600 ms)

Question 23

benign lesions of endocardial origin. most common primary cardiac tumor and represent 50^ of all benign cardiac masses and 25% of all primary cardiac tumors

Answer 23

Myxoma

Question 24

arises from undifferentiated and totipotent mesenchymal stem cell and have a gelatinous compositin described as an acid mucopolysaccharide-rich stroma. Usually occurs in 4th to 7th decade of life, and commonly in females

Answer 24

myxoma

Question 25

cardiac tumor that may be related to carney complex

Answer 25

myxoma

Question 26

Include hyperpigmented skin lesions, endocrinopathy, and extracardiac neoplasms such as breast fibroadenomas, melanotic schwannomas or pituitray adenomas

Answer 26

Carney complex

Question 27

majority of myxomas occur on what chamber

Answer 27

left atrium; majority arising from the interatrial septum ner the fossa ovalis

Question 28

embolization in atrial myxomas, are more worrisome on what chamber of involvement

Answer 28

left atrium

Question 29

benign lesions which constitute approximately 10% of all primary cardiac tumors. Consists of encapsulated mature adipose cells which are commonly well-defined, round or oval in shape, and broad-based

Answer 29

Lipoma

Question 30

Majority of cardiac lipomas arise from the

Answer 30

epicardial surface and extend outward into the pericardial space

Question 31

presence of chemical shift/"India ink" artifact at the interface between the lipoma and the surrounding tissue on SSFP sequences is another characteristic finding of

Answer 31

lipoma

Question 32

Feature that differentiates cardiac lipomas from lipomatous hypertrophy of the interatrial septum

Answer 32

location of the lesion within the interatrial septum with sparing of the fossa ovalis will allow differentiation of lipomatous hypertrophy from a true lipoma

Question 33

benign endocardial based lesions which constitute approximately 10% of all primary cardiac tumors. They contain avascular dense connective tissue covered in a single layer of endothelium

Answer 33

papillary fibroelastoma

Question 34

accounts for 75% of all valvular neoplasms

Answer 34

papillary fibroelastoma

Question 35

most papillary fibroelastoma occurs where

Answer 35

aortic and mitral valves, usually on the aortic side of the aortic valve and atrial side of AV vales, away from the free edge of the leaflet

Question 36

usually the best modality to detect and evaluate papillary fibroelastomas

Answer 36

echocardiography

Question 37

Key MRI finding in distinguishing fibroelastoma from a vegetation, which is a main differential diagnosis for a valvular mass

Answer 37

presence of delated gadolinium enhancement

Question 38

Aside from delayed gadolinium enhancement of fibroelastoma, what other features can differentiate it from vegetation

Answer 38

vegetations represent infected thrombi, there is often destruction of the associated valve with valvular or perivalvular regurgitation, which is absent with fibroelastoma

Question 39

benign congenital tumors which are the most common primary tumors in infants and children

Answer 39

rhabdomyoma

Question 40

they are hamartomas of altered enlarged cardiac myocytes which arise as small intramural nodules in the ventricular myocardium, measuring between 1 and 3 cm on average

Answer 40

rhabdomyoma

Question 41

50% of cases of rhabdomyoma are seen in patients with ____ and are usually multiple

Answer 41

tuberous sclerosis

Question 42

most rhabdomyomas will regress at what age

Answer 42

before 4 years old

Question 43

this tumor can be detected on pre- or postnatal echocardiograms, seen as solid hyperechoic masses either within the ventricular myocardium or intracavitary and attached to the myocardium

Answer 43

rhabdomyomas

Question 44

True or false: Rhabdomyomas are difficult to detect on CT, with minimal to no enhancement

Answer 44

true

Question 45

benign fibrous hamartomas which are the second most common cardiac tumors in infants and children

Answer 45

fibroma

Question 46

nonencapsulated fibrous tumors composed of neoplastic fibroblasts and abundant collagen. they are typically solitary, intramural tumors measuring between 2 and 7 cm

Answer 46

fibroma

Question 47

common location for fibroma

Answer 47

left ventricular wall or interventricular septum

Question 48

Fibroma is associated with what syndrome, which is an autosomal dominant syndrome of basal cell carcinoma, odontogenic keratocysts and other neoplasms

Answer 48

Gorlin syndrome (aka basal cell nevus syndrome)

Question 49

true or false: 1/2 to 2/3 of the cardiac fibromas are symptomatic, with a range of symptoms including chest pain, heart failure, arrhythmias, syncope or sudden cardiac death

Answer 49

true

Question 50

cardiac tumor that appears as well-defined, homogeneous low attenuation mass located within the left ventricular myocardium on CT. coarse calcifications are present in 15 to 20% of cases and are often located centrally

Answer 50

fibromas

Question 51

while fibromas are avscular and will show no enhancement during perfusion imaging, they will clasically show intense enhancement with late gadolinium imaging due to

Answer 51

their large amount of collagen creating an expanded extracellular space for contrast to pool into

Question 52

rare cardiac tumor that account for 5% to 10% of all primary benign cardiac tumors. they are composed of vascular endothelial cells and can be AV, capillary or cavernous in type

Answer 52

hemangioma

Question 53

50% of cardiac hemangioma are of what type

Answer 53

AV type, which made up of dysplastic arterial and venous structures

Question 54

hemangiomas can be located in any part of the heart with 75% of cases being

Answer 54

intramural

Question 55

cardiac hemangiomas are associated with _____, which is characterized by multiple hemangiomas causing recurrent thrombocytopenia and consumptive coagulopathy

Answer 55

Kasabach-Merritt syndrome

Question 56

Rare cardiac tumors derived from clustered neuroendocrine cells and are cloely related to pheochromocytomas

Answer 56

paraganglioma

Question 57

Myxoma can be present in patients with the ____ trid, which is made up of extra-adrenal pheochromocytoma, GIST and pulmonary chondroma

Answer 57

Carney triad

Question 58

paragangliomas commonly occur in what chamber

Answer 58

left atrial wall, in the location of the normal cardiac paraganglioma cells, typically involving either the left atrial roof or posterior wall

Question 59

highly specific imaging for cardiac paragangliomas

Answer 59

focal cardiac abnormal uptake on iodine-123 or iodine-131 metaiodobenzylguanidine scintigraphy

Question 60

germ cell tumors made up of several different types of tissue, they are commonly found in infants/children as complex multilocular, heterogeneous cystic masses growing within the pericardial sac, typically on the right side. Usually large in size and associated with a pericardial effusion

Answer 60

teratoma

Question 61

benign abnormal collections of lymphatic vessels which are rare benign neoplasms, most commonly found in children

Answer 61

cardiac lymphangiomas

Question 62

typically multiloculated cystic lesions within the pericardial space and may be associated with a chylous pericardial effusion

Answer 62

cardiac lymphangiomas

Question 63

extremely rare and are composed of hypertrophied disorganized myocytes with interstitial fibrosis

Answer 63

cardiac hamartomas

Question 64

cardiac hamartomas commonly occur at what chamber

Answer 64

left ventricular myocardium

Question 65

most common cardiac mass found in adult population

Answer 65

metastatic disease

Question 66

most common metastatic lesion to the heart

Answer 66

lung cancer, followed by hematologic malignancies, breast ca and esophageal ca

Question 67

most common route of spread in cardiac metastatic disease

Answer 67

direct invasion or lymphatic extension to the pericardium and epicardium

Question 68

malignancies that are common to spread to the heart hematogeneously and usually result in intramural involvement

Answer 68

melanomas, renal cell ca and sarcomas

Question 69

most common findings in imaging heart for metastatic disease

Answer 69

pericardial involvement and/or intracavitary masses

Question 70

neoplastic lesions which arise from the mesenchymal cells within the cardiac muscle. most common primary malignant tumor of the heart, accounting for 1/3 of cases and include several subtypes

Answer 70

sarcoma

Question 71

most common differentiated cardiac sarcoma

Answer 71

angiosarcoma

Question 72

most common primary cardiac malignancy in childhood

Answer 72

rhabdomyosarcoma

Question 73

only cardiac sarcoma that predominately arises in the RA in the region of the right AV groove. encasement of the right coronary artery is a common finding

Answer 73

cardiac angiosarcoma

Question 74

characteristic enhancement finding in angiosarcoma

Answer 74

intense enhancement within the soft tissue component of the tumor and rapid enhancement on first pass perfusion

Question 75

true or false: while angiosarcomas predominate in theRA and rhabdomyosarcoma have no chamber predilection, the other histologic subtypes of cardiac sarcomas usually occur in the LA

Answer 75

true

Question 76

cardiac lymphoma is usually of what type

Answer 76

non-Hodgkin B cell type

Question 77

cardiac lymphoma is often related with what infection

Answer 77

Epstein- Barr virus

Question 78

primary cardiac lymphima commonly involves what side of the heart

Answer 78

right side, particularly RA, with predilection for the right AV groove

Question 79

unique feature of this cardiac malignancy is its tendency to extend along the epicardium, encasing adjacent structures including the coronary arteries, aortic root or pulmonary vessels

Answer 79

lymphoma

Question 80

lymphoma may be distinguished from other cardiac tumors by what characteristic

Answer 80

homogeneous MRI signal throughout the lesion

Question 81

most common intracardiac lesion and can involve any cardiac chamber

Answer 81

thrombus

Question 82

thrombus is often best delineated during what phase of imaging

Answer 82

portal venous phase, where it appears hypodense to the normally enhancing myocardium

Question 83

imaging of choice in distinguishing thrombus from tumor

Answer 83

CMR

Question 84

acute thrombus demonstrates what signal on T1W and T2W

Answer 84

hyperintense

Question 85

chronic thrombus will demonstrate what signal on T1W and T2W

Answer 85

hypointense

Question 86

subacute thrombus will appear as what on T1W and T2W

Answer 86

hyperintense on T1W and hypointense on T2W

Question 87

true or false: chronic organised thrombus may demonstrate peripheral enhancement on late gadolinium enhancement imaging due to fibrous material forming around it

Answer 87

true

Question 88

benign process characterized by proliferation of adipose cells within the interatrial septum. occurs in 8% of population and can be associated with an increased body mass index and large amount of epicardial fat

Answer 88

lipomatous hypertrophy of the interatrial septum

Question 89

on cross sectional imaging, it will demonstrate dumbbell-shaped fatty mass in the interatrial septum, commonly with asymmetric enlargement of its posterolateral component. dumbbell spade is created by the sparing of the fossa ovalis

Answer 89

lipomatous hypertrophy of the interatrial septum

Question 90

normal septal thickness

Answer 90

less than 1 cm

Question 91

lipomatous hypertrophy of interatrial septum can measure up to

Answer 91

2cm or greater

Question 92

key feature in lipomatous hypertrophy of interatrial septum that helps in distinguishing it from other abnormalities

Answer 92

sparing of fossa ovalis

Question 93

adherent lesions made up of platelets, fibrin and inflammatory cells that seed the valvular leaflets, usually in an area of endocardial injury

Answer 93

vegetations

Question 94

noninfective endocarditis are rare and can be due to

Answer 94

nonbacterial thrombotic endocarditis seen in the setting of malignancy or Libman-Sacks endocarditis which occurs in patients with SLE

Question 95

two most common normal anatomic structures that may appear as pseudomasses

Answer 95

crista terminalis and eustachian valve

Question 96

vertically oriented smooth muscle ridge within the RA which extends from SVC to IVC. it is a normal anatomic structure which demarcates the area of embryologic fusion of primitive RA and sinus venosus

Answer 96

crista terminalis

Question 97

normal ridge of tissue at the junction of the RA and IVC, which in utero directed blood flow from the IVC into the fossa ovalis

Answer 97

eustachian valve