Skip to main content

Advertisement

SpringerLink
Log in

Multimodal echocardiography in the diagnosis of masses localized to the proximal portions of pulmonary arteries

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Proximal pulmonary artery masses are exceedingly rare, and their diagnosis and therapy are important and challenging for clinicians. This study reviews our experience exploring the value of a combination of transthoracic echocardiography and contrast echocardiography for the differential diagnosis of proximal pulmonary artery masses. Between January 2018 and June 2021, 44 patients diagnosed with a mass attached to the major pulmonary artery and straddling the bilateral pulmonary arteries or pulmonary valve on transthoracic echocardiography were referred to this study. Contrast echocardiography was performed in 17 patients. Masses were diagnosed based on their site of attachment, shape, size, mobility, hemodynamic consequences on transthoracic echocardiography, and tissue perfusion on contrast echocardiographic perfusion imaging. Pathological data were collected from medical records and analyzed. The most frequent location of proximal pulmonary artery masses was the major pulmonary artery trunk. Twelve patients underwent complete mass resection, whereas nine patients underwent percutaneous pulmonary artery biopsy puncture and had a pathological diagnosis. Another 24 patients were confirmed with the validation methods. Contrast echocardiography has good sensitivity and specificity for differentiating thrombi from pulmonary artery sarcomas (PAS). The mass types were distributed as follows: thrombi (19, 43%), PAS (15, 34%), metastatic tumors (6, 14%), vegetations (3, 7%), and primary benign lesions (1, 2%). The majority of proximal pulmonary artery masses were thrombi or PAS. A combination of transthoracic echocardiography and contrast echocardiography offers advantages in the early identification of proximal pulmonary masses and provides clinically important information about the characteristics of masses, especially for differentiating thrombi from PAS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Torbicki A, Galie N, Covezzoli A, Rossi E, De Rosa M, Goldhaber SZ (2003) ICOPER Study Group. Right heart thrombi in pulmonary embolism: results from the international cooperative pulmonary embolism registry. J Am Coll Cardiol 41:2245–2251

    Article  Google Scholar 

  2. Alam M (1993) Pitfalls in the echocardiographic diagnosis of intracardiac and extracardiac masses. Echocardiography 10:181–191

    Article  CAS  Google Scholar 

  3. Peters PJ, Reinhardt S (2006) The echocardiogramphic evaluation of intracardiac masses: a review. J Am Soc Echocardiogr 19:230–240

    Article  Google Scholar 

  4. Patel R, Lim RP, Saric M, Nayar A, Babb J, Ettel M, Axel L, Srichai MB (2016) Diagnostic performance of cardiac magnetic resonance imaging and echocardiography in evaluation of cardiac and paracardiac masses. Am J Cardiol 117:135–140

    Article  Google Scholar 

  5. Tang QY, Guo LD, Wang WX, Zhou W, Liu YN, Liu HY, Li L, Deng YB (2015) Usefulness of contrast perfusion echocardiography for differential diagnosis of cardiac masses. Ultrasound Med Biol 41:2382–2390

    Article  Google Scholar 

  6. Srivali N, Yi ES, Ryu JH (2017) Pulmonary artery sarcoma mimicking pulmonary embolism: a case series. QJM 110:283–286

    CAS  PubMed  Google Scholar 

  7. Garçon P, Cohen I, Nakad C, Marini V, Abassade P, Antakly Y, Cador R (2008) Diagnosis of proximal pulmonary embolism by transthoracic echocardiography. J Am Soc Echocardiogr 21:1079

    Article  Google Scholar 

  8. Vu M, Harrison BA, DeStephano C, Odell J (2008) Endocarditis, vegetation, and perforation of the pulmonary valve. J Cardiothorac Vasc Anesth 22:261–262

    Article  Google Scholar 

  9. Kirkpatrick JN, Wong T, Bednarz JE, Spencer KT, Sugeng L, Ward RP, DeCara JM, Weinert L, Krausz T, Lang RM (2004) Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. J Am Coll Cardiol 43:1412–1419

    Article  Google Scholar 

  10. Bruce CJ (2011) Cardiac tumours: diagnosis and management. Heart 97:151–160

    Article  Google Scholar 

  11. Hudzik B, Miszalski-Jamka K, Glowacki J, Lekston A, Gierlotka M, Zembala M, Polonski L, Gasior M (2015) Malignant tumors of the heart. Cancer Epidemiol 39:665–672

    Article  Google Scholar 

  12. Butany J, Nair V, Naseemuddin A, Nair GM, Catton C, Yau T (2005) Cardiac tumours: diagnosis and management. Lancet Oncol 6:219–228

    Article  Google Scholar 

  13. Reynen K (1996) Frequency of primary tumors of the heart. Am J Cardiol 77:107

    Article  CAS  Google Scholar 

  14. Centofanti P, Di Rosa E, Deorsola L, Dato GM, Patanè F, La Torre M, Barbato L, Verzini A, Fortunato G, di Summa M (1999) Primary cardiac tumors: early and late results of surgical treatment in 91 patients. Ann Thorac Surg 68:1236–1241

    Article  CAS  Google Scholar 

  15. Meng Q, Lai H, Lima J, Tong W, Qian Y, Lai S (2002) Echocardiographic and pathologic characteristics of primary cardiac tumors: a study of 149 cases. Int J Cardiol 84:69–75

    Article  Google Scholar 

  16. Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ (2003) Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J 146(3):404–410

    Article  Google Scholar 

  17. Fidler IJ (1995) Critical factors in the biology of human cancer metastasis. Am Surg 61:1065–1066

    CAS  PubMed  Google Scholar 

  18. Lindner JR (2002) Assessment of myocardial viability with myocardial contrast echocardiography. Echocardiography 19:417–425

    Article  Google Scholar 

  19. Mengozzi G, Rossini R, Palagi C, Musumeci G, Petronio A, Limbruno U, Caravelli P, Bello VD, Mariani M (2002) Usefulness of intravenous myocardial contrast echocardiography in the early left ventricular remodeling in acute myocardial infarction. Am J Cardiol 90:713–719

    Article  Google Scholar 

  20. Porter TR, Abdelmoneim S, Belcik JT, McCulloch ML, Mulvagh SL, Olson JJ, Porcelli C, Tsutsui JM, Wei K (2014) Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr 27:797–810

    Article  Google Scholar 

  21. van Kan C, van der Plas MN, Reesink HJ, van Steenwijk RP, Kloek JJ, Tepaske R, Bonta PI, Bresser P (2016) Hemodynamic and ventilatory responses during exercise in chronic thromboembolic disease. J Thorac Cardiovasc Surg 152:763–771

    Article  Google Scholar 

  22. Jenkins DP, Biederman A, D’Armini AM, Dartevelle PG, Gan HL, Klepetko W, Lindner J, Mayer E, Madani MM (2016) Operability assessment in CTEPH: lessons from the CHEST-1 study. J Thorac Cardiovasc Surg 152:669–674

    Article  Google Scholar 

  23. Palaskas N, Thompson K, Gladish G, Agha AM, Hassan S, Iliescu C, Kim P, Durand JB, Lopez-Mattei JC (2018) Evaluation and management of cardiac tumors. Curr Treat Options Cardiovasc Med 20:29

    Article  Google Scholar 

  24. Greaves SC, Zhi G, Lee RT, Solomon SD, MacFadyen J, Rapaport E, Menapace FJ, Rouleau JL, Pfeffer MA (1997) Incidence and natural history of left ventricular thrombus following anterior wall acute myocardial infarction. Am J Cardiol 80:442–448

    Article  CAS  Google Scholar 

  25. Yin K, Zhang Z, Luo R, Ji Y, Zheng D, Lin Y, Wang C (2018) Clinical features and surgical outcomes of pulmonary artery sarcoma. J Thorac Cardiovasc Surg 155:1109–1115

    Article  Google Scholar 

  26. Sun T, Lu GL, Fang J, Xie SB (2020) Transthoracic echocardiography for evaluation of an intrapulmonary artery mass. Adv Ultrasound Diagn Therapy 4:329–334

    Article  Google Scholar 

  27. Nomoto N, Tani T, Konda T, Kim K, Kitai T, Ota M, Kaji S, Imai Y, Okada Y, Furukawa Y (2017) Primary and metastatic cardiac tumors: echocardiographic diagnosis, treatment and prognosis in a 15-years single center study. J Cardiothorac Surg 12:103

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Ting Sun and Guo-Liang Lu have contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasonography, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Ting Sun

  2. Department of Cardiovascular Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151 Yanjiang West Road, Guangzhou, 510120, China

    Guo-Liang Lu, Lun-Chao Ma, Jie-Zhou Huang & Shao-Bo Xie

Authors
  1. Ting Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guo-Liang Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lun-Chao Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jie-Zhou Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shao-Bo Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shao-Bo Xie.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, T., Lu, GL., Ma, LC. et al. Multimodal echocardiography in the diagnosis of masses localized to the proximal portions of pulmonary arteries. Int J Cardiovasc Imaging 38, 149–158 (2022). https://doi.org/10.1007/s10554-021-02427-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-021-02427-5

Keywords

Search

Navigation