Cardiac Masses & Tumors Flashcards
What is the most common primary benign cardiac tumor found in adults? (80% of all tumors)
myxoma
etiology of myxoma
- most are idiopathic
- 10% genetic
- more common in female
- patients often young (~20 yrs old)
characteristics of myxoma
- most are pendunculated in the IAS
- different texture than myocardium; myxoid, gelatinous, smooth, lobular, friable (increased embolos risk
- often hinders diastolic filling
- if mobile, secondary valvular stenosis likely
signs & symptoms of myxoma
- asymptomatic
- arrhythmia
- arthralgia (joint pain)
- CP
- clubbing of fingerprints
- cough
- dizziness/fainting
- embolism and associated fingings
- fever/flu-like symptoms
- HF
- regurgitation
- Raynaud’s phenomenon (blood vessel spasm, usually in the fingers/toes
Treatment of myxoma
If the patient is a surgical candidate, immediate surgical removal of the myxoma is recommended.
*_entire myxoma must be removed t_o decrease the risk of reoccurrence
What are the primary benign intracardiac tumors?
myxoma
papilary fibroelastoma
fibroma
lipoma
rhabdomyoma
What is the most common benign valvular tumor?
papillary fibroelastoma (papilloma)
What is papillary fibroelastoma?
believed to originate from a small thrombus that attaches and grow into a sense, mobile mass
highly mobile and life-threatening, complication may arise due to embolism, stroke
*resemble chordae tendineae
In adults, which part of the body does papillary fibroelastoma affect most?
AoV
LVOT
anterior MV leaflet
What is fibroma?
- bulky tumor that is frequently embedded in the myocardial wall of the ventricles or the IVS
- typically presents during childhood
- heart transplant may be indicated if children with a vary large LV fibroma
Fibroma is associated with ________
ventricular arrhythmia
LVOT
HF
sudden death
What is lipoma?
- an encapsulated tumor composed of mature fat cells that is usually soft and may become large
- usually asymptomatic and found incidentally *appear echogenic
- most lipomas do not require treatment unless if symptoms are present (arrhythmia, embolus, coronary artery compression)
What are these?
LHIS (lipomatous hypertrophy of the interatrial septum
a fatty infiltration of the interatrial septum sparring the fossa ovalis (gives dumb-bell shape); most prevalent in elderly and/or obese patients
What is the most common fetal cardiac tumor?
rhabdomyoma
many are diagnosed within a year of life and greater than 90% are diagnosed by the age 15
primary cardiac malignant tumors are rare; the majority are _______
sarcoma
________ is the most common type of sarcoma; usually begins with in the _____ or on the ______.
Angiosarcoma
RA
pericardium
*Note: A carcinoma forms in the skin or tissue cells that line the body’s internal organs, such as the kidneys and liver. A sarcoma grows in the body’s connective tissue cells, which include fat, blood vessels, nerves, bones, muscles, deep skin tissues and cartilage.
RA angiosarcoma tends to create _____ and/or _____ obstruction and associated findings.
inflow
outflow
____ % metastasize, so the treatment depends on patient’s age, health, the degree of metastasis, and the location and size of sarcoma
80
what is autotrasplantation?
the heart is removed, the tumor is removed, and the heart is put back into the patient.
secondary tumors are more common than primary ones; they often appear in the terminal phase of an ongoing disease (poor prognosis).
Most secondary cardiac tumors are (metastasized from):
lung, breast, renal carcinoma
malignant melanoma
The patient with secondary cardiac tumors may present with:
P.E
tamponade
HF
arrhythmia
*treatment depends on the primary malignancy and usually palliative care
carcinoid heart disease is the result of a metastasizing carcinoid tumor, usually from _____ or _____ that secrets _____
appendix
ileum
serotonin
*Note: Carcinoid syndrome occurs when a rare cancerous tumor called a carcinoid tumor secretes certain chemicals into your bloodstream, causing a variety of signs and symptoms. A carcinoid tumor, which is a type of neuroendocrine tumor, occurs most often in the gastrointestinal tract or the lungs.
if the tumor metastasizes to the liver, the serotonin is deposited on the ________ of the right heart. Serotonin does not travel to the left heart because serotonin is inactivated in the _______
endocardial linings
lungs
extracardiac tumor is anywhere within the vicinity (the area near or surrounding a particular place) of the heart such as (7) :
- mediastinal cyst: a mediastinal tumor can be caused by an enlarged lymph node, or a gland such as the thymus, thyroid, or parathyroid. It can also be caused by a cyst originating from the pericardium, the bronchus, or the esophagus.
- hematoma:
- thymoma: is a tumor originating from the epithelial cells of the thymus that is considered a rare malignancy.
- teratoma: is a rare type of germ cell tumor that may contain immature or fully formed tissue, including teeth, hair, bone and muscle. Teratomas may be cancerous or noncancerous, and they can affect people of all ages.
- infradiaphragmatic tumor
- pancreatic cyst
- pleural tumor
a thrombus usually forms in the areas of akinesis or dyskinesis; typically associated with _______ and found in the ventricular apex.
anterior MI
If the patient is in Afib, it is very important to rule out
____ and/or _____ thrombus prior to cardioversion
LA
LAA
left atrial thrombus is usually associated with: (3)
MS
LA enlargement
Afib
Echo steps to interrogate possible thrombus: (5)
- improve resolution (possible high frequency) and focus on the apex
- utilize CFD to see if it fills the apex or travel around the thrombus
- use different depth to differentiate artifact vs thrombus
- use various windows
- document the thrombus or mass in at least two views
What is missiles?
a foreign body such as a bullet, knife, nail
The patient is rushed to the ED after accidentally shooting a nail from a nail gun into his chest; echo is ordered to rule out: (7)
- P.E/tamponade
- coronary artery trauma
- myocardial rupture
- ASD
- VSD
- WMA
- valvular disruption/regurgitation (new murmur)
A detailed knowledge of cardiac anatomy and normal variants is not required for the recognition of structures that may mimic a cardiac mass.
T or F ?
F
A detailed knowledge of cardiac anatomy and normal variants allows recognition of structures that may mimic a cardiac mass.
Myocardial Trabeculations are differentiated from thrombi by their linear shape with an echodensity similar to and attachment to the myocardium.
T or F ?
T
Thrombi never form on permanent pacer leads in the right atrium or ventricle.
T or F ?
F
Thrombi also may form on permanent pacer leads in the right atrium or ventricle.
Right-sided echo contrast is helpful in identifying thrombus when image quality is suboptimal.
T or F ?
T
List 4 structures that may be mistaken for an Abnormal Cardiac Mass in the Right Atrium.
crista terminalis
chiari network
pacer wire, Swan-Ganz catheter, central venous line
trabeculation
atrial suture after cardiac transplant
*CVC (central venous catheter/line) also known as a central line(c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centrally located veins is often needed in critically ill patients, or in those requiring prolonged intravenous therapies, for more reliable vascular access.
Lambl’s excrescences and nodules of Arantius are structures that may appear as abnormal attached to the ___________________ valve.
AoV
*The nodule of Arantius is a nodular thickening at the central portion of the free edge of each leaflet. During systole, each leaflet is pushed aside by the flow of blood leaving the left ventricle.
*Lambi’s excrescences: may exist on either native and prosthetic cardiac valves 1-4. Typically, they form at the lines of valve closure, most commonly of the mitral and aortic valves, with the right heart valves affected in less than 10% of all cases
Typical Cardiac Tumor Locations
3 Normal Intracardiac Structures that may be misdiagnosed as abnormal:
prominent eustachian valve
prominent crista terminalis
prominent pectinate muscle in LAA
Eustachian valves and Chiari networks are thin filamentous structures that extend from the region of the _____1_____ toward the ______2______
Eustachian valves and Chiari networks are thin filamentous structures that extend from the region of the inferior vena cava (IVC) toward the superior vena cava (SVC)
*List 2 extra cardiac pericardial malignant masses.
Mesothelioma
Angiosarcoma
What is this?
Angiosarcoma (malignant)
are malignant sarcomas of vascular endothelial cell origin. Endothelial cells make up the lining of vessels. Angiosarcomas can occur in any region of the body, although they are most commonly located in the skin, breast, liver, and deep tissue.
What is this?
papillary fibroelastoma
Tumor features frond-like extensions and very mobile with stalk-like attachment to Aortic valve leaflet. Most frequently attach to midportion of valve leaflets
benign but can be deadly
sometimes called cardiac papillomas. These small, noncancerous tumors develop in the heart — most often on one of the valves located between the heart chambers
What is this?
renal cell carcinoma
Most common cardiac tumor in infants and children
Rhabdomyoma
