Advertisement

CT for intracardiac thrombi and tumors

  • Servet Tatli
  • Martin J. LiptonEmail author
Article

Abstract

Although cardiac tumors are rare, they nevertheless represent an important subgroup, the diagnosis of which is challenging for the primary care physician. Symptoms are not characteristic and serious complications including stroke, myocardial infarction and even sudden death from arrhythmia may be the first signs of tumor. The most common primary cardiac neoplasm is the benign myxoma and the most frequent primary malignant lesion is sarcoma. Cardiac metastases from distant primary carcinomas are now frequently encountered. Echocardiography until the past decade was the only consistently reliable and available non-invasive diagnostic tool. New non-invasive CT and MRI exams are changing the diagnostic approach. Echocardiography and angiocardiography with or without coronary arteriography remain routine methods for evaluating cardiac neoplasms. However, CT provides additional diagnostic information and is regarded as essential for adequate staging and treatment planning, particularly when surgical resection is being considered. This chapter reviews the wide spectrum of intracardiac thrombi and tumors including their incidence and imaging characteristics with particular reference to the CT findings and differential diagnosis.

Keywords

cardiac lesions cardiac tumors CT scanning diagnostic imaging intracardiac mass thrombi 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bouchard, A, Lipton, MJ, Farmer, DW,  et al. 1987Evaluation of regional ventricular wall motion by ECG-gated CT.J Comput Assist Tomogr11969974CrossRefPubMedGoogle Scholar
  2. 2.
    Ringertz, HG, Skioldebrand, CG, Refsum, H, Tyberg, JV, Napel, SA, Lipton, MJ 1982A comparison between the information in gated and nongated cardiac CT images.J Comput Assist Tomogr6933938PubMedGoogle Scholar
  3. 3.
    Berninger, WH, Redington, RW, Doherty, P, Lipton, MJ, Carlsson, E 1979Gated cardiac scanning: canine studies.J Comput Assist Tomogr3155163PubMedGoogle Scholar
  4. 4.
    Lackner, K, Thurn, P 1981Computed tomography of the heart: ECG-gated and continuous scans.Radiology140413420PubMedGoogle Scholar
  5. 5.
    Kachelrie, BM, Ulzhiemer, S, Kalender, WA 2002ECG-correlated image reconstruction from multi-slice spiral CT scans of the heart.Med Phys2718811902Google Scholar
  6. 6.
    Flohr, T, Ohnesorge, B 2001Heart rate adaptive optimization of spatial and temporal resolution for electrocardiogram-gated multislice spiral CT of the heart.J Comput Assist Tomogr25907923CrossRefPubMedGoogle Scholar
  7. 7.
    Boese, JM, Bahner, ML, Albers, J, van Kaick, G. 2000[Optimizing temporal resolution in CT with retrospective ECG gating]Radiologe40123129CrossRefPubMedGoogle Scholar
  8. 8.
    Albers, J, Boese, JM, Vahl, CF, Hagl, S 2003In vivo validation of cardiac spiral computed tomography using retrospective gating.Ann Thorac Surg75885889CrossRefPubMedGoogle Scholar
  9. 9.
    Kachelriess, M, Ulzheimer, S, Kalender, WA 2000ECG-correlated image reconstruction from subsecond multi-slice spiral CT scans of the heart.Med Phys2718811902CrossRefPubMedGoogle Scholar
  10. 10.
    McAllister, H,Jr., Fenoglio, J.,Jr. 1978Tumors of the cardiovascular system In: Fascicle 15, Second Series, Atlas of Tumor Pathology.Armed Forces Institute of PathologyWashington, DCGoogle Scholar
  11. 11.
    Hackworth C, Lipton M. The cardiovascular system. In: Curati W, Cosgrove D, Lipton M, Allison D editors. Imaging in Oncology. London, England: Greenwich Medical Media Limited, 1998; 191--202.Google Scholar
  12. 12.
    McAllister Jr. H. Tumors of the heart and pericardium. In: Silver M editor. Cardiovascular Pathology. New York: Churchill Livingstone, 1983, Ch. 35.Google Scholar
  13. 13.
    Markel, ML, Waller, BF, Armstrong, WF 1987Cardiac myxoma. A review.Medicine (Baltimore)66114125Google Scholar
  14. 14.
    Peters, MN, Hall, RJ, Cooley, DA, Leachman, RD, Garcia, E 1974The clinical syndrome of atrial myxoma.Jama230695701PubMedGoogle Scholar
  15. 15.
    St John Sutton, MG, Mercier, LA, Giuliani, ER, Lie, JT 1980Atrial myxomas: a review of clinical experience in 40 patients.Mayo Clin Proc55371376PubMedGoogle Scholar
  16. 16.
    Vidaillet, HJ,Jr, Seward, JB, Fyke, FE,3rd, Su, WP, Tajik, AJ. 1987“Syndrome myxoma”: a subset of patients with cardiac myxoma associated with pigmented skin lesions and peripheral and endocrine neoplasmsBr Heart J57247255PubMedGoogle Scholar
  17. 17.
    Danoff, A, Jormark, S, Lorber, D, Fleischer, N 1987Adrenocortical micronodular dysplasia, cardiac myxomas, lentigines, and spindle cell tumors.Report of a kindred. Arch Intern Med147443448PubMedGoogle Scholar
  18. 18.
    Burke, AP, Virmani, R 1993Cardiac myxoma.A clinicopathologic study. Am J Clin Pathol100671680PubMedGoogle Scholar
  19. 19.
    Boussen, K, Moalla, M, Blondeau, P, Ben Ayed, H, Lie, JT 1991Embolization of cardiac myxomas masquerading as polyarteritis nodosa.J Rheumatol18283285PubMedGoogle Scholar
  20. 20.
    Grebenc, ML, Rosado-de-Christenson, ML, Green, CE, Burke, AP, Galvin, JR 2002Cardiac myxoma: imaging features in 83 patients.Radiographics22673689PubMedGoogle Scholar
  21. 21.
    Pindyck, F, Peirce, 2nd EC, Baron, MG, Lukban, SB 1972Embolization of left atrial myxoma after transseptal cardiac cathertization.Am J Cardiol30569571PubMedGoogle Scholar
  22. 22.
    Godwin, JD, Herfkens, RJ, Skioldebrand, CG, Brundage, BH, Schiller, NB, Lipton, MJ 1981Detection of intraventricular thrombi by computed tomography.Radiology138717721PubMedGoogle Scholar
  23. 23.
    Goldstein, JA, Schiller, NB, Lipton, MJ, Ports, TA, Brundage, BH 1986Evaluation of left ventricular thrombi by contrast-enhanced computed tomography and two-dimensional echocardiography.Am J Cardiol57757760PubMedGoogle Scholar
  24. 24.
    Tuna, IC, Julsrud, PR, Click, RL, Tazelaar, HD, Bresnahan, DR, Danielson, GK 1991Tissue characterization of an unusual right atrial mass by magnetic resonance imaging.Mayo Clin Proc66498501PubMedGoogle Scholar
  25. 25.
    Barberger-Gateau, P, Paquet, M, Desaulniers, D, Chenard, J 1978Fibrolipoma of the mitral valve in a child.Clinical and echocardiographic features. Circulation58955958Google Scholar
  26. 26.
    Tatli, S, O’Gara, PT, Lambert, J, Kwong, R, Byrne, JG, Yucel, EK 2004MRI of atypical lipomatous hypertrophy of the interatrial septum.AJR Am J Roentgenol182598600PubMedGoogle Scholar
  27. 27.
    Spooner, EW, Farina, MA, Shaher, RM, Foster, ED 1982Left ventricular rhabdomyoma causing subaortic stenosis- the two-dimensional echocardiographic appearance.Pediatr Cardiol26771PubMedGoogle Scholar
  28. 28.
    Guereta, LG, Burgueros, M, Elorza, MD, Alix, AG, Benito, F, Gamallo, C 1986Cardiac rhabdomyoma presenting as fetal hydrops.Pediatr Cardiol7171174PubMedGoogle Scholar
  29. 29.
    Kuehl, KS, Perry, LW, Chandra, R, Scott, 3rd LP 1970Left ventricular rhabdomyoma: a rare cause of subaortic stenosis in the newborn infant.Pediatrics46464468PubMedGoogle Scholar
  30. 30.
    Violette, EJ, Hardin, NJ, McQuillen, EN 1981Sudden unexpected death due to asymptomatic cardiac rhabdomyoma.J Forensic Sci26599604PubMedGoogle Scholar
  31. 31.
    Pillai, R, Kharma, N, Brom, AG, Becker, AE 1991Mitral valve origin of pedunculated rhabdomyomas causing subaortic stenosis.Am J Cardiol67663664PubMedGoogle Scholar
  32. 32.
    Fisher, M, Higgins, C, Andereck, W 1985Magnetic resonance imaging of an intrapericardial pheochromocytoma.J Comput Tomogr911031105Google Scholar
  33. 33.
    Hamilton, BH, Francis, IR, Gross, BH,  et al. 1997Intrapericardial paragangliomas (pheochromocytomas): imaging features.AJR Am J Roentgenol168109113PubMedGoogle Scholar
  34. 34.
    Putnam, JB,Jr, Sweeney, MS, Colon, R, Lanza, LA, Frazier, OH, Cooley, DA. 1991Primary cardiac sarcomasAnn Thorac Surg51906910PubMedCrossRefGoogle Scholar
  35. 35.
    Schmaltz, AA, Apitz, J 1982Primary rhabdomyosarcoma of the heart.Pediatr Cardiol27375PubMedGoogle Scholar
  36. 36.
    MacDonald, S, Fay, JE, Lynn, RB 1983Intrapericardial teratoma: a continuing challenge.Can J Surg268182PubMedGoogle Scholar
  37. 37.
    Maeta, H, Hiyama, T, Okamura, K,  et al. 1982Successful excision of intracardiac teratoma.J Thorac Cardiovasc Surg83909913PubMedGoogle Scholar
  38. 38.
    Kadir, S, Coulam, CM 1980Intracaval extension of renal cell carcinoma.Cardiovasc Intervent Radiol3180183PubMedGoogle Scholar
  39. 39.
    Penn, I 1978Malignancies associated with immunosuppressive or cytotoxic therapy.Surgery83492502PubMedGoogle Scholar
  40. 40.
    Penn, I 1979Tumor incidence in human allograft recipients.Transplant Proc1110471051PubMedGoogle Scholar
  41. 41.
    Lipton M. Rejection in the cardiac transplant ‘the role of X-ray examination’. In: Cardiac Imaging: X-ray, MR and Ultrasound. Amsterday: Excerpta medica 1991; 159--170.Google Scholar
  42. 42.
    Sane, DC, Feldman, JM 1987A blush from the heart.Chest92360361PubMedGoogle Scholar
  43. 43.
    Mattingly, T 1965The functioning carcinoid tumor: a serendipity in diagnosis.Am Clin Climatol Assoc77190204Google Scholar
  44. 44.
    Topol, EJ, Fortuin, NJ 1984Coronary artery spasm and cardiac arrest in carcinoid heart disease.Am J Med77950952PubMedGoogle Scholar
  45. 45.
    Millward, MJ, Blake, MP, Byrne, MJ, Hung, J, Gibson, P 1989Left heart involvement with cardiac shunt complicating carcinoid heart disease.Aust N Z J Med19716717PubMedGoogle Scholar
  46. 46.
    Kvols, LK, Moertel, CG, O’Connell, MJ, Schutt, AJ, Rubin, J, Hahn, RG 1986Treatment of the malignant carcinoid syndrome.Evaluation of a long-acting somatostatin analogue.N Engl J Med315663666PubMedCrossRefGoogle Scholar
  47. 47.
    Oates, JA 1986The carcinoid syndrome.N Engl J Med315702704PubMedCrossRefGoogle Scholar
  48. 48.
    Mullins, PA, Hall, JA, Shapiro, LM 1990Balloon dilatation of tricuspid stenosis caused by carcinoid heart disease.Br Heart J63249250PubMedGoogle Scholar
  49. 49.
    Abner A. Approach to the patient who presents with superior vena cava obstruction. Chest 1993; 103(4 Suppl): 394S--397S.Google Scholar
  50. 50.
    Gooding, GA, Hightower, DR, Moore, EH, Dillon, WP, Lipton, MJ 1986Obstruction of the superior vena cava or subclavian veins: sonographic diagnosis.Radiology159663665PubMedGoogle Scholar
  51. 51.
    Bechtold, RE, Wolfman, NT, Karstaedt, N, Choplin, RH 1985Superior vena caval obstruction: detection using CT.Radiology157485487PubMedGoogle Scholar
  52. 52.
    Kim, HJ, Kim, HS, Chung, SH 1993CT diagnosis of superior vena cava syndrome: importance of collateral vessels.AJR Am J Roentgenol161539542PubMedGoogle Scholar
  53. 53.
    Bigsby, R, Greengrass, R, Unruh, H 1993Diagnostic algorithm for acute superior vena caval obstruction (SVCO).J Cardiovasc Surg (Torino)34347350Google Scholar
  54. 54.
    Oudkerk, M, Kuijpers, TJ, Schmitz, PI, Loosveld, O, de, Wit R 1996Self-expanding metal stents for palliative treatment of superior vena caval syndrome.Cardiovasc Intervent Radiol19146151PubMedGoogle Scholar
  55. 55.
    Shah, R, Sabanathan, S, Lowe, RA, Mearns, AJ 1996Stenting in malignant obstruction of superior vena cava.J Thorac Cardiovasc Surg112335340PubMedGoogle Scholar
  56. 56.
    Tassi, A, Cirocchi, R, Volpi, G, Pacifici, A, Goracci, G 1993Preoperative evaluation of inferior vena cava involvement secondary to malignant abdominal neoplasms.J Cardiovasc Surg (Torino)34241247Google Scholar
  57. 57.
    Savarese, DM, Rohrer, MJ, Pezzella, AT, Davidoff, A, Fraire, AE, Menon, M 1995Successful management of intracardiac extension of tumor thrombus in a patient with advanced nonseminomatous germ cell testicular cancer.Urology46883887PubMedGoogle Scholar
  58. 58.
    Uemoto, S, Fleming, W, Keogh, BE, Habib, NA 1995Combined pulmonary tumour embolectomy and extended right hepatectomy with inferior vena cava resection for advanced hepatocellular carcinoma.Br J Surg82127128PubMedGoogle Scholar
  59. 59.
    Laissy, JP, Soyer, P, Sekkal, SR,  et al. 1995Assessment of vascular involvement with magnetic resonance angiography (MRA) in Pancoast syndrome.Magn Reson Imaging13523530PubMedGoogle Scholar
  60. 60.
    Mavroudis, C, Way, LW, Lipton, M, Gertz, EW, Ellis, RJ 1981Diagnosis and operative treatment of intracavitary liposarcoma of the right ventricle.J Thorac Cardiovasc Surg81137140PubMedGoogle Scholar
  61. 61.
    Kircher, B, Abbott, JA, Pau, S,  et al. 1991Left atrial volume determination by biplane two-dimensional echocardiography: validation by cine computed tomography.Am Heart J121(3 Pt 1)864871Google Scholar
  62. 62.
    van der Velde, ET, van Dijk, AD, Steendijk, P,  et al. 1992Left ventricular segmental volume by conductance catheter and Cine-CT.Eur Heart J13 (Suppl E)1521Google Scholar
  63. 63.
    Wood, AM, Hoffmann, KR, Lipton, MJ 1994Cardiac function.Quantification with magnetic resonance and computed tomography.Radiol Clin North Am32553579PubMedGoogle Scholar
  64. 64.
    Higgins, CB, Byrd, BF,3rd, Stark, D,  et al. 1985Magnetic resonance imaging in hypertrophic cardiomyopathy.Am J Cardiol5511211126PubMedGoogle Scholar
  65. 65.
    Diethelm, L, Simonson, JS, Dery, R, Gould, RG, Schiller, NB, Lipton, MJ 1989Determination of left ventricular mass with ultrafast CT and two-dimensional echocardiography.Radiology171213217PubMedGoogle Scholar
  66. 66.
    Sechtem, U, Higgins, CB, Sommerhoff, BA, Lipton, MJ, Huycke, EC 1987Magnetic resonance imaging of restrictive cardiomyopathy.Am J Cardiol59480482PubMedGoogle Scholar
  67. 67.
    Schwartz, AB, Mitchell, RS, Higgins, CB, Lipton, MJ, Klausner, SC 1986Invasive calcific constrictive pericarditis simulating a left ventricular mass.Am Heart J112861863PubMedGoogle Scholar
  68. 68.
    Stark, DD, Higgins, CB, Lanzer, P,  et al. 1984Magnetic resonance imaging of the pericardium: normal and pathologic findings.Radiology150469474PubMedGoogle Scholar
  69. 69.
    Smiseth, OA, Frais, MA, Junemann, M,  et al. 1991Left and right ventricular diastolic function during acute pericardial tamponade.Clin Physiol116171PubMedGoogle Scholar
  70. 70.
    Moncada, R, Baker, M, Salinas, M,  et al. 1982Diagnostic role of computed tomography in pericardial heart disease: congenital defects, thickening, neoplasms, and effusions.Am Heart J103263282PubMedGoogle Scholar
  71. 71.
    Thomason, R, Schlegel, W, Lucca, M, Cummings, S, Lee, S 1994Primary malignant mesothelioma of the pericardium.Case report and literature review. Tex Heart Inst J21170174Google Scholar
  72. 72.
    DiCarlo, LA,Jr., Schiller, NB, Herfkens, RL, Brundage, BH, Lipton, MJ 1982Noninvasive detection of proximal pulmonary artery thrombosis by two-dimensional echocardiography and computerized tomography.Am Heart J104(4 Pt 1)879881Google Scholar
  73. 73.
    Leef J, MJ L. Pulmonary artery imaging. In: Schlant RC, Alexander R, Lipton M editors. Diagnostic Atlas of the Heart. New York: McGraw-Hill, 1996; 333--350.Google Scholar
  74. 74.
    Giger, ML, Pelizzari, CA 1996Advances in tumor imaging.Sci Am275110112PubMedCrossRefGoogle Scholar
  75. 75.
    Hoffmann KR, Chen S, Carrol JD, Lipton MJ. Digital imaging of the heart. In: Schlant R, Alexander R, Lipton M editors. Diagnostic Atlas of the Heart. New York: McGraw-Hill 1996; 351--374.Google Scholar
  76. 76.
    Karczmar, GS, Kuperman, VY, River, JN, Lewis, MZ, Lipton, MJ 1994Magnetic resonance measurement of response to hyperoxia differentiates tumors from normal tissue and may be sensitive to oxygen consumption.Invest Radiol29 (Suppl 2)S161CrossRefGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  1. 1.Brigham & Women’s HospitalBostonUSA

Personalised recommendations