Echocardiographic Approach to the Diagnosis of Cardiac Tumors

Abstract

Echocardiography has changed the prognosis of cardiac tumors which was in the past poor not only for malignant, but also for benignant lesions. In fact, cardiac masses could not be suspected until progressive obstruction of cardiac chambers and/or embolic events occurred. The ultrasound diagnosis of cardiac tumors depends on the technological level of the instrumentation and on the operator’s skill and experience, which is particularly true for small and unusual lesions. The cardiologist performing the examination should know the clinical history of the patient and should be expert on the wide spectrum of cardiac masses which may be occasionally encountered during a routine examination.

However, the histological differentiation of cardiac masses or even the ability to simply distinguish between a malignant and a benignant mass is still very difficult with ultrasound, and sometimes even at surgical inspection. Therefore, the histological diagnosis at surgery is always necessary to make a correct and definitive diagnosis and to optimize therapy. Despite these important limitations, some ultrasound characteristics as the number of masses, their location, dimensions, their ultrasound texture, their vascularization, and the presence of calcification, may help suggesting the histological type. Intraoperative transesophageal echocardiography is useful to guide surgery and to evaluate the results of valve repair in case of infiltration of the atrioventricular valves or to confirm the absence of intracardiac shunts after septal repair.