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Cardiac > Cardiac Masses > Flashcards

Cardiac Masses Flashcards

1
Q

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

A

Thrombus

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2
Q

20 to 40 times more common than primary cardiac tumors

A

Tumors due to metastatic disease

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3
Q

First line inaging technique used to evaluate cardiac masses

A

Echocardiography

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4
Q

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

A

restrospective ECG gating

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5
Q

imaging modality of choice in evaluating cardiac masses

A

Cardiac MRI

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6
Q

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

A

Gradient echo cine imaging

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7
Q

most cardiac tumors demonstrate what MRI signal characteristics

A

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

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8
Q

Key MRI imaging sequences for evaluation of lesion vascularity and enhancement

A

Postcontrast T1 based perfusion and late gadolinium enhancement images

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9
Q

Size and number of lesions in benign cardiac mass

A

small, <5 cm and single

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10
Q

Usual location of a benign cardiac mass

A

left sided

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11
Q

Marginal characteristics of benign cardiac masses

A

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

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12
Q

Pericardial involvement in benign cardiac masses

A

no involvement

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13
Q

Tissue characteristics of benign cardiac mass

A

homogeneous, absent to minimal early enhancement, variable delayed enhancement

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14
Q

size and number of lesions in malignant cardiac masses

A

large, >5 cm, multiple

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15
Q

usual location of malignant cardiac mass

A

right sided

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16
Q

margins of a malignant cardiac mass

A

irregular, ill-defined, direct invasion through tissue places

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17
Q

pericardial involvement in malignant cardiac mass

A

hemorrhagic pericardial effusion, pericardial invasion or multiple nodular masses

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18
Q

tissue characteristics of malignant cardiac mass

A

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

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19
Q

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

A

Steady state free precession cine images (SSFP)

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20
Q

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

A

myocardial tissue tagging

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21
Q

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

A

myocardial tissue tagging

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22
Q

MRI technique that can distinguish a thrombus from a tumor

A

longer invesion recovery times (such as 600 ms)

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23
Q

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

A

Myxoma

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24
Q

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

A

myxoma

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25
Q

cardiac tumor that may be related to carney complex

A

myxoma

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26
Q

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

A

Carney complex

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27
Q

majority of myxomas occur on what chamber

A

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

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28
Q

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

A

left atrium

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29
Q

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

A

Lipoma

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30
Q

Majority of cardiac lipomas arise from the

A

epicardial surface and extend outward into the pericardial space

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31
Q

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

A

lipoma

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32
Q

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

A

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

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33
Q

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

A

papillary fibroelastoma

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34
Q

accounts for 75% of all valvular neoplasms

A

papillary fibroelastoma

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35
Q

most papillary fibroelastoma occurs where

A

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

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36
Q

usually the best modality to detect and evaluate papillary fibroelastomas

A

echocardiography

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37
Q

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

A

presence of delated gadolinium enhancement

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38
Q

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

A

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

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39
Q

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

A

rhabdomyoma

40
Q

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

A

rhabdomyoma

41
Q

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

A

tuberous sclerosis

42
Q

most rhabdomyomas will regress at what age

A

before 4 years old

43
Q

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

A

rhabdomyomas

44
Q

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

A

true

45
Q

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

A

fibroma

46
Q

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

A

fibroma

47
Q

common location for fibroma

A

left ventricular wall or interventricular septum

48
Q

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

A

Gorlin syndrome (aka basal cell nevus syndrome)

49
Q

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

A

true

50
Q

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

A

fibromas

51
Q

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

A

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

52
Q

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

A

hemangioma

53
Q

50% of cardiac hemangioma are of what type

A

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

54
Q

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

A

intramural

55
Q

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

A

Kasabach-Merritt syndrome

56
Q

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

A

paraganglioma

57
Q

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

A

Carney triad

58
Q

paragangliomas commonly occur in what chamber

A

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

59
Q

highly specific imaging for cardiac paragangliomas

A

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

60
Q

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

A

teratoma

61
Q

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

A

cardiac lymphangiomas

62
Q

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

A

cardiac lymphangiomas

63
Q

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

A

cardiac hamartomas

64
Q

cardiac hamartomas commonly occur at what chamber

A

left ventricular myocardium

65
Q

most common cardiac mass found in adult population

A

metastatic disease

66
Q

most common metastatic lesion to the heart

A

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

67
Q

most common route of spread in cardiac metastatic disease

A

direct invasion or lymphatic extension to the pericardium and epicardium

68
Q

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

A

melanomas, renal cell ca and sarcomas

69
Q

most common findings in imaging heart for metastatic disease

A

pericardial involvement and/or intracavitary masses

70
Q

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

A

sarcoma

71
Q

most common differentiated cardiac sarcoma

A

angiosarcoma

72
Q

most common primary cardiac malignancy in childhood

A

rhabdomyosarcoma

73
Q

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

A

cardiac angiosarcoma

74
Q

characteristic enhancement finding in angiosarcoma

A

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

75
Q

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

A

true

76
Q

cardiac lymphoma is usually of what type

A

non-Hodgkin B cell type

77
Q

cardiac lymphoma is often related with what infection

A

Epstein- Barr virus

78
Q

primary cardiac lymphima commonly involves what side of the heart

A

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

79
Q

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

A

lymphoma

80
Q

lymphoma may be distinguished from other cardiac tumors by what characteristic

A

homogeneous MRI signal throughout the lesion

81
Q

most common intracardiac lesion and can involve any cardiac chamber

A

thrombus

82
Q

thrombus is often best delineated during what phase of imaging

A

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

83
Q

imaging of choice in distinguishing thrombus from tumor

A

CMR

84
Q

acute thrombus demonstrates what signal on T1W and T2W

A

hyperintense

85
Q

chronic thrombus will demonstrate what signal on T1W and T2W

A

hypointense

86
Q

subacute thrombus will appear as what on T1W and T2W

A

hyperintense on T1W and hypointense on T2W

87
Q

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

A

true

88
Q

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

A

lipomatous hypertrophy of the interatrial septum

89
Q

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

A

lipomatous hypertrophy of the interatrial septum

90
Q

normal septal thickness

A

less than 1 cm

91
Q

lipomatous hypertrophy of interatrial septum can measure up to

A

2cm or greater

92
Q

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

A

sparing of fossa ovalis

93
Q

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

A

vegetations

94
Q

noninfective endocarditis are rare and can be due to

A

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

95
Q

two most common normal anatomic structures that may appear as pseudomasses

A

crista terminalis and eustachian valve

96
Q

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

A

crista terminalis

97
Q

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

A

eustachian valve

Cardiac (8 decks)

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