Intracardiac Masses Flashcards
What are essentials of diagnosis of intracardiac masses?
- Rare but critical
- Confirmation requires tissue biopsy (but H&P and imaging hold valuable diagnostic clues)
- Surgical excision is mainstay of treatment
What are the 2 types of intracardiac tumors?
Primary and metastasis
If a patient is symptomatic, a cardiac mass can almost always be detected by what?
Echo, MRI, and/or CT
What determines the clinical findings of cardiac tumors?
Anatomic location and size
What are characteristics of a endocardial cardiac tumor?
- Thromboembolism: cerebral, coronary. pulmonary, systemic
- Cavitary obliteration or outflow tract obstruction
- Valve obstruction and valve damage
- Constitutional manifestations
What are characteristics of a valvular cardiac tumor?
- Valvular damage, obstruction, or regurgitation
- Congestive heart failure
- Sudden death or syncope
What are characteristics of a pericardial tumor?
- Pericarditis
- Pericardial effusion
- Arrhythmias
- Tamponade
- Constriction
What are characteristics of a myocardial cardiac tumor?
- Arrhythmias, ventricular or atrial
- Conduction abnormalities
- Electrocardiographic changes
- Systolic or diastolic left ventricular dysfunction
- Coronary involvement: angina, infarction
How are cardiac tumors diagnosed?
- May be discovered as abnormal cardiac contour on CXR
- Echo (but may miss ventricular wall tumors)
- Cardiac MRI/gated CT = diagnostric procedure of choice
How are cardiac tumors managed?
- Surgical excsision = mainstay, especially if symptomatic
- Some require radiation or chemo
- Cardiac transplantation for unresectable cardiac tumors or extensive infiltration
What is the epidemiology of benign primary tumors?
- Rare (.02%)
- Cardiac myxoma = traditional MC tumor in adults
- Now papillary fibroelastomas thought higher frequency
- Rhabdomyomas MC in kids
What is the epidemiology of myxomas?
- 50% of benign cardiac tumors
- Usually between 30 and 60 years old, mean age at diagnosis = 51
- Familial autosomal dominant mean age = 25 and more likely have multiple recurrent tumors
What are characteristics of myxomas?
- Pedunculated and gelatinous consistency
- Surface smooth, irregular, or friable
What are friable or villous myxomas associated with? Larger myxomas?
- Friable or villous = higher risk of embolization
- Larger tumors = obstructive cardiovascular symptoms
How do the majority of myxomas present?
- In L atrium with stalk attached to interatrial septum (near fossa ovalis)
- Presents with tumor plop
What is a tumor plop?
- Obstruction of mitral valve opening by tumor
- Early diastolic heart sound
Later than opening snap of a stenotic mitral valve and earlier than S3
How is a myxoma diagnosed?
- Echo or pathology of embolic material
- Cardiac MRI = adjunct
How is a myxoma treated?
Surgical excision
What is the epidemiology of a papillary fibroelastoma?
- 8% of cardiac tumors
- Usually patients >60
- Also called papillary endocardial tumor, cardiac papilloma, or giant Lambl’s excrescence
What are characteristics of papillary fibroelastoma?
- Looks like sea anemone
- Attaches to endocardial surface of valves by pedicle
- MC left-sided valves, AV > MV
what are clinical manifestations of papillary fibroelastoma?
- Cerebral embolism
- Myocardial Infarction
- Sudden death
- Pulmonary embolism
- Syncope
What are characteristics of lipomas?
Account for 8% of primary cardiac tumors
* Solitary, circumscribed, encapsulated with wide range of size and weight
* Location: subendocardial protruding into cardiac chamber, arise in epicardial space and grow into pericardial space, or intramyocardial lesion
What is the epidemiology of fibroma?
- More commonly in pediatric population
- Second MC benign pediatric cardiac tumor
What is the location of fibromas?
- Any chamber
- MC ventricular myocardium, especially anterior wall of LV and interventricular septum
