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Cardiac Imaging > Cardiac Tumors > Flashcards

Cardiac Tumors Flashcards

1
Q

Cardiac Tumors — epidemiology?

A

~25% are malignant
~75% are benign
myxoma (~50%) > metastasis (~20%) > lipoma (~10%) > papillary fibroelastoma (~10%)

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2
Q

Cardiac Tumors — features suggesting malignancy?

A

Invasion of extra-cardiac structures
Involvement of more than one cardiac chamber
Involvement of the right side of the heart
Tissue inhomogeneity
poor definition of borders
greater than 5cm diameter
presence of pericardial or pleural effusion

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3
Q

myxoma — epidemiological facts?

A

~50% of primary cardiac tumors in adulthood
more common in females — 3:1 (f:m)
7% with atypical behaviour — familial predisposition or as part of the Carney complex

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4
Q

Carney complex — facts?

A

autosomal dominant inheritance syndrome — myxomas, hyperpigmented skin lesions, extracardiac tumors (pituitary adenomas, breast fibroadenomas, melanotic schwannomas)

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5
Q

myxoma — appearance / MRI diagnosis?

A 
well defined, spherical, intracavitary mass
lobular contours, inhomogeneous
~25% broad-based
~75% pedunculated
Cine-SSFP: mobile
T1w: isointense to myocardium
T2w: hyperintense
CE+ less than myocardium
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6
Q

myxoma — clinical symptoms?

A

Symptoms are often unspecific

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7
Q

myxoma — complications?

A

obstruction
arrhythmia
embolic events
interference with mitral valve

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8
Q

myxoma — differential diagnosis (DDx)?

A 
thrombus
lipoma
papillary fibroelastoma
endocarditic vegetations
prominent crista terminalis
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9
Q

myxoma — therapy?

A

surgical removal

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10
Q

cardiac lipoma - definition ?

A

benign cardiac neoplasia

deriving from neoplastic proliferative adipocytes

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11
Q

cardiac lipoma — epidemiology?

A

2nd most common cardiac neoplasia in adulthood ~10%

equally common in female and male

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12
Q

myxoma — localisation?

A

~75% left atrium (LA) mostly atrial septum, fossa ovalis
~20% right atrium
~5% ventricles

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13
Q

cardiac lipoma — appearance / MRI diagnosis?

A 
mostly homogeneous encapsulated tumors
sometimes septa
T1w: hyperintense
T2w: hyperintense 
no contrast enhancement (CE-)
FS: hypointense
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14
Q

cardiac lipoma — localisation?

A

~50% subendocardial
~25% intramyocardial
~25% subepicardial
most often located in the right atrium

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15
Q

cardiac lipoma — clinical symptoms?

A

mostly asymptomatic

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16
Q

cardiac lipoma — complications?

A

arrhythmia

embolic events

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17
Q

cardiac lipoma — therapy?

A

case-dependant

surgical removal

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18
Q

cardiac lipoma — differential diagnosis (DDx) ?

A

thrombi
myxoma
papillary fibroelastoma
lipomatous hypertrophy of the atrial septum

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19
Q

lipomatous hypertrophy of the atrial septum — facts?

A 
characterised by fatty infiltration of the atrial septum
sparing of fossa ovalis
prevalence estimated 1-8%
incidence increasing with age
brown fat cells
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20
Q

papillary fibroelastoma — epidemiology?

A

3rd most common primary cardiac tumor in adulthood
~10% of all primary cardiac tumors
~70% of all primary heart valve tumors
peak age ~6th decade

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21
Q

papillary fibroelastoma — appearance / MRI diagnosis?

A 
usually < 2cm in size
pedunculated, sea-anemone like
T1w: hypointense
T2w: hyperintense 
CE-
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22
Q

papillary fibroelastoma — localisation ?

A

~90% on heart valves
~29% aortic, ~25% mitral, ~17% tricuspid, ~13% pulmonary valve
~10% somewhere else on endocard

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23
Q

papillary fibroelastoma — clinical symptoms ?

A

mostly asymptomatic

dependant on localisation

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24
Q

papillary fibroelastoma — complications ?

A 
obstruction (coronary ostium)
embolic events (eg TIA)
also paradoxical with PFO
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25
Q

papillary fibroelastoma — aetiology ?

A

multiple different theories (harmatoma / thrombus)
can develop after cardiac surgery
associated with endothelial injury
most probable mechanical irritation

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26
Q

papillary fibroelastoma — differential diagnosis (DDx) ?

A

thrombi
endocarditic vegetations
valvular myxoma

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27
Q

papillary fibroelastoma — therapy ?

A

case dependant

surgical removal

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28
Q

cardiac fibroma — what is it ?

A

harmatoma, consisting of fibroblasts, collagen and elastic fibres

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29
Q

cardiac fibroma — epidemiology ?

A

2nd most common primary cardiac tumor in childhood
~10% of all primary cardiac tumors in childhood
~15% of cardiac fibromas are diagnosed in adulthood

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30
Q

cardiac fibroma — appearance and MRI diagnosis ?

A

intramural
calcifications in ~25%
Cine-SSFP: isointense to myocardium
T1w: isointense to myocardium
T2w: mildly hyperintense in childhood, hypointense with increasing age and in adulthood (specific)
no enhancement in first pass perfusion
peripheral enhancement and hypointense core on LGE

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31
Q

cardiac fibroma — localisation ?

A

left ventricular free wall > right ventricular free wall > septum

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32
Q

cardiac fibroma — clinical symptoms ?

A

dependant on localisation and implications
arrhythmia
outflow obstruction
ischemia

33
Q

cardiac fibroma — complications ?

A

arrhythmia
ischemia
outflow obstruction
sudden death

34
Q

cardiac fibroma — therapy ?

A

case dependant
asymptomatic — no therapy because of complicated surgery
symptomatic — surgical removal

35
Q

cardiac fibroma — prognosis?

A

no tendency of spontaneous regression
increase of collagen fibres with age (T2w increasingly hypointense)
septal localisation, large size, young age have worse prognosis

36
Q

cardiac fibroma — differential diagnosis (DDx) ?

A 
cardiac rhabdomyoma
hypertrophic cardiomyopathy (HCM)
hemangioma
37
Q

cardiac hemangioma — facts ?

A

non-neoplastic venous malformation

~50% cavernous

38
Q

cardiac hemangioma — epidemiology ?

A

~3% of all cardiac tumors

39
Q

cardiac hemangioma — appearance, MRI diagnosis ?

A

T1w: isointense
T2w: hyperintense, homogeneous
fast wash in in first pass perfusion

40
Q

cardiac hemangioma — clinical symptoms ?

A

variable

dependant on size, localisation and implications

41
Q

cardiac hemangioma — complications ?

A

arrhythmia
pericardial effusion / haemorrhage
cerebral apoplex

42
Q

cardiac hemangioma — therapy ?

A

case dependant

surgical resection

43
Q

cardiac hemangioma — differential diagnosis (DDx) ?

A

all cardiac tumors

rhabomyoma

44
Q

cardiac lymphoma — facts ?

A

primary cardiac lymphoma
non Hodgkin lymphoma (NHL), B-cell lymphoma
associated with immunosuppression

45
Q

cardiac lymphoma — epidemiology ?

A

~1.3% of all cardiac tumors

age peak of~60 years

46
Q

cardiac lymphoma — appearance, MRI diagnosis ?

A

T1w: isointense
T2w: hyperintense
CE+
diffusion restriction

47
Q

cardiac lymphoma — clinical symptoms ?

A

B-symptoms

fatigue, weight loss, night-sweats

48
Q

cardiac lymphoma — complications ?

A

pericardial effusion
pericardial tamponade
heart failure
arrhythmia

49
Q

cardiac lymphoma — therapy ?

A

chemotherapy: Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone (R-CHOP)
autologous stem cell transplant

50
Q

cardiac lymphoma — differential diagnosis (DDx) ?

A

sarcoma
amyloidosis
sarcoidosis

51
Q

cardiac angiosarcoma — epidemiology ?

A

most common primary malignant cardiac tumor ~30%
male > female — 2-3:1
peak age 4th decade

52
Q

cardiac angiosarcoma — localisation ?

A 
right atrium (RA) most common
two types:
intracavitary growth
infiltration of the pericard
53
Q

cardiac angiosarcoma — appearance, MRI diagnosis ?

A

two types: intracavitary growth, infiltration of the pericard
T1w: isointense with hyperintense spots and flow voids
T2w: hyperintense
CE+

54
Q

cardiac angiosarcoma — clinical symptoms ?

A

unspecific

dependant on subtype

55
Q

cardiac angiosarcoma — complications ?

A

right heart failure

pericardial effusion / haemorrhage / tamponade

56
Q

cardiac angiosarcoma — therapy ?

A

multimodal

57
Q

cardiac angiosarcoma — differential diagnosis (DDx) ?

A
  • all malignant cardiac tumors
  • cardiac lymphoma (respects more anatomical structures)
  • Erdheim-Chester-disease (respects anatomical structures)
58
Q

cardiac rhabdomyosarcoma — epidemiology ?

A

most common malignant cardiac tumor in childhood

~20% of all primary malignant cardiac tumors

59
Q

cardiac rhabdomyosarcoma — appearance, MRI diagnosis ?

A 
infiltrative growth
necrotic areas
often multiple locations
T1w: isointense 
T2w: hyperintense 
CE+ inhomogenous enhancement
60
Q

cardiac rhabdomyosarcoma — clinical symptoms & complications ?

A

unspecific symptoms: fatigue, weight loss
dependant on localisation: outflow obstruction
pericardial effusion

61
Q

cardiac rhabdomyosarcoma — therapy and prognosis ?

A

Therapy : surgical resection — often not entirely possible

Prognosis : often death within a year

62
Q

cardiac metastasis — epidemiology ?

A

2nd most common cardiac tumor after myxoma
up to 40 times more common than primary malignant cardiac tumors
in 3-18% of all patients with malignancies
absolutely most frequent in breast and lung cancer
relatively most frequent in melanoma

63
Q

cardiac metastasis — appearance, MRI diagnosis ?

A 
intramural or intracavitary
often multiple
T1w: hypo or isointense
T2w: hyperintense 
CE+
T1 hyperintense, T2 hypointense (melanoma)
64
Q

cardiac metastasis — localisation ?

A

RV>LV>RA>LA

65
Q

cardiac metastasis — therapy

A

usually chemotherapy because of late stage

66
Q

cardiac metastasis — differential diagnosis (DDx) ?

A

myxoma
thrombi
primary malignant cardiac tumors

67
Q

cardiac thrombus — epidemiology ?

A

most frequent intracavitary tumor like lesion

incidence between 3-21% depending on age

68
Q

cardiac thrombus — aetiology and pathophysiology ?

A

intracavitary areas with low blood flow or stasis
atrial fibrillation, mitral stenosis
myocardial infarction, left ventricular aneurysm
cardiomyopathy

69
Q

cardiac thrombus — localisation / predilection sites ?

A

left atrial appendage — atrial fibrillation, mitral stenosis

left ventricular apex — myocardial infarction, aneurysm

70
Q

cardiac thrombus — diagnosis ?

A

dependant on localisation
left atrium / left atrial appendage — TEE (CT)
left ventricle — MRI (CT)

71
Q

cardiac thrombus — MRI findings ?

A

early LGE: intracavitary filling defect
acute thrombi: T1w and T2w intermediary
subacute thrombi: T1w hyperintense, T2w hypointense (methemoglobin)
chronic thrombi: T1w and T2w hypointense (fibrous remodeling)

72
Q

cardiac thrombus — complications ?

A

embolic events

~15% of ischaemic cerebral infarcts

73
Q

cardiac thrombus — therapy ?

A

anticoagulation

left atrial clipping

74
Q

Cardiac masses — role of MRI ?

A

I1 Indication

  • confirmation of presence and localisation of cardiac tumors
  • assessment of tumour size and locoregional extension
  • mass characterisation (T1w, T2w, T1wCE, EGE, LGE)
  • assessment of haemodynamic effect
  • surgical therapy planning
75
Q

Cardiac masses - assessment ?

A
  • confirmation of a mass / tumour
  • location and anatomical relationship
  • size
  • form and margins
  • motion and functional significance
  • tissue characteristics (T1, T2, CE)
  • tumour associated complications
  • features suggesting malignancy
  • differentiation
76
Q

Cardiac masses - indicators of benignancy ?

A
  • origin in left atrium
  • single lesion
  • smooth margins
  • encapsulated lesion
  • endocavitary growth
77
Q

Cardiac masses - non-neoplastic origin ?

A
  • normal or hypertrophic cardiac structures (e.g. crista terminalis)
  • echocardiographic artefacts
  • thrombi
  • intraparietal haematoma
  • pseudoaneurysms
  • granulomatous disease
  • focal hypertrophic cardiomyopathy
78
Q

Cardiac paraganglioma - facts ?

A
  • T2w hyperintense
  • rich vascular supply
  • LA>RA>aortic bulb
  • catecholamine production
  • DDx: cardiac hemangioma

Cardiac Imaging (9 decks)

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